A new study published in the October issue of Obstetrics & Gynecology revealed that women with uterine leiomyomas, who undergo uterine artery embolization, are at higher risk of additional surgery including hysterectomy, but lower risk for complications compared with those undergoing myomectomy.
“The real-world evidence on the comparative effectiveness between alternative procedural treatments for leiomyoma-related bulk symptoms is sparse,” the researchers noted. “Specifically, extant evidence demonstrates substantial variation in the re-intervention rates and reproductive outcomes between different leiomyoma treatment procedures.”
The research team led by Bijan Borah, associate professor at the Mayo Clinic in Rochester, collated and analyzed the data of 135,522 women (age 18–54 years) received from the commercial insurance database. Among 135,522 women, 82% had the hysterectomy, 14.7% underwent myomectomy, 3.1% had uterine artery embolization (UAE), and 0.0003% women underwent magnetic resonance-guided, focused ultrasound surgery.
The researchers aimed to compare the probability of re-intervention in various uterine-sparing leiomyoma surgeries. Hence they performed a more limited and comparative analysis of those data by focusing only on myomectomy and UAE, as there were only 47 women in the cohort underwent the focused ultrasound therapy.
The women who underwent UAE had a higher rate of re-interventions than those who had the myomectomy (17.1% vs. 15.0%; P value = 0.02). Additionally, it was correlated to a higher rate of following hysterectomy than myomectomy (13.2% vs. 11.1%; P < 0.01), but a lower rate of intervention-specific complications (18.1% vs. 24.6%; P < .001). The present study showed significantly higher re-intervention rate for uterine artery embolization than the previous studies, noted the authors.
Compared to those who had UAE, the pregnancy rates were higher for those with myomectomy (2.2% vs. 7.5%). Among women who became pregnant, the rates of adverse pregnancy outcomes were similar for both interventions.
“The lower pregnancy rate for uterine artery embolization was likely attributable in part to both patient and healthcare provider preference toward myomectomy for pregnancy optimization, which is also supported by the American College of Obstetricians and Gynecologists,” the researchers noted.
The study has certain limitations that it fails to capture information on women's reproductive intentions and only 10% of black women involved in the study, so the study results might not be applicable for them. So further studies focusing specifically on black women are required because as many as 80% of black women experience leiomyomas.
The researchers concluded that women who undergo UAE have a higher risk of reintervention, lower risk of other surgical procedure, but have a comparable rate of adverse reproductive outcomes. The study findings would guide help clinicians counseling their patients regarding alternative interventions to hysterectomy to manage uterine leiomyomas