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Uterine artery embolisation a safe option for fibroids

Obstetrics and gynaecology

Obstetrics and gynaecology

Uterine fibroids are commonly asymptomatic but can cause menorrhagia and pressure symptoms on adjacent structures, such as the bladder and bowel. The only effective treatments were hysterectomy and myomectomy until, in the 1990s, uterine artery embolisation (UAE), a minimally invasive technique, was developed.

There have been no randomised trials comparing UAE with hysterectomy. However, a study, in the BJOG, has made a retrospective comparison of two cohorts of women and found that UAE is a safe and effective option.

Hysterectomy data were collected from 459 women who had their operations performed during a national audit in 1994-5. UAE data were collected from 649 women between 1996 and 2002.

The groups showed considerable demographic differences.

Women who underwent UAE were more educated, less parous, less likely to smoke and more likely to be black.

The average length of follow-up was 8.6 years for women who had a hysterectomy and 4.6 years for women who had UAE.

Hysterectomy was associated with greater relief of fibroid symptoms (99% compared with 85%, P= <0.001) and more women reported feeling better since treatment (96% compared with 84%, P= <0.001).

However, hysterectomy was associated with more complications than UAE. Patients experienced severe or major complications in 14.8% and 4.5% of cases respectively.

Nearly 20% of women who had UAE required further treatment for fibroids, of whom half had a hysterectomy. Twenty-seven of the women who had UAE went on to become pregnant. There were 19 live births, with a 79% caesarean section rate.

More women who had UAE said they would recommend the procedure to a friend than women who had a hysterectomy (91% and 86%, P= 0.007).

The data from this study imply that a significant proportion of women benefited from UAE, and the incidence of complications was significantly less with UAE than with hysterectomy.

It is difficult to be certain what data really signify when the patient groups are not comparable. However, UAE seems to be a useful, safe and less invasive option for women with symptomatic fibroids.

Dutton S, Hirst A, McPherson K et al. A UK multicentre retrospecetive cohort study comparing hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids (HOPEFUL study): main results on medium-term safety and efficacy. BJOG 2007;114:1340-51

Reviewer

Dr Chris Barclay
GP, Sheffield

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