Uterine fibroids: risk of recurrence after myomectomy in a Nigerian population

Abstract

Purpose: To determine the recurrence rate and risk factors for recurrence following myomectomy.

Methods: Two hundred and thirty-two women who had open myomectomy were followed up for 3-10 years. Clinical features as well as pelvic ultrasound scan were used to evaluate the patients for recurrence. Recurrence rate was computed and the risk factors for recurrence were determined using Odd ratio comparing the Sociodemographic characteristics, preoperative symptoms, surgical and pathologic findings in the two groups of patients.

Results: The mean age and parity of the patients were 29.3 ± 3.8 years and 1.2 ± 1.1, respectively. The desire for procreation after surgery was noted in 183 (78.9%) of the patients while the rest desired resolution of symptoms. More than half of the patients had multiple symptoms. Intraoperatively, 63 (7.2%) had single fibroid removed while the rest were multiple varying from 2 to 67 pieces. The overall recurrence rate during the follow-up period was 20.7% (48/232) at 10 years and this increases with time. Positive family history of uterine fibroids, multiple uterine fibroids, and persistence or recurrence of three or more of the pre-myomectomy symptoms were significantly associated with the recurrence of uterine fibroids (OR = 21.83, 3.14, and 3.49, respectively) while pregnancy after myomectomy and the use of oral contraceptive pills (OCP) were protective.

Conclusion: There is a high recurrence of uterine fibroid after myomectomy in our environment. The risk is higher among women with positive family history, multiple uterine fibroids, and in those with multiple symptoms. Pregnancy and use of OCP are protective.