Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jun 3;2(1):18.
doi: 10.1186/s42155-019-0061-5.

Implementation of uterine artery embolization for symptomatic fibroids in the Netherlands: an inventory and preference study

Annefleur M de Bruijn  1 , Jolijn Huisman  2 , Wouter J K Hehenkamp  3 , Paul N M Lohle  4 , Jim A Reekers  5 , Anne Timmermans  6 , Andries R H Twijnstra  7
Affiliations

Implementation of uterine artery embolization for symptomatic fibroids in the Netherlands: an inventory and preference study

Annefleur M de Bruijn et al. CVIR Endovasc. .

Abstract

Background and purpose: The Dutch national guideline on heavy menstrual bleeding was updated and published in 2013. It recommended (for the first time) that uterine artery embolization (UAE) should be part of counseling of women with symptomatic fibroids. We aimed to evaluate the implementation of UAE for symptomatic uterine fibroids in the Netherlands and to investigate gynecologists preference and other influential factors.

Methods: The primary outcome was to examine the UAE/hysterectomy ratio before and after introduction of the 2013 guideline by the use of annual hospital reports. The secondary outcome assessed factors that could influence implementation by means of a questionnaire to gynecologists.

Results: A total of 29/30 (97%) UAE+ hospitals and 36/52 (69%) UAE- hospitals sent their annual reports. The UAE/hysterectomy percentages in 2012, 2013 and 2014 were 7,0%, 7.0% and 6.9%, respectively. Regarding the questionnaire, the response rates were 88% and 91%, respectively. In both groups we observed a high self-perceived tendency for UAE counseling (90% versus 70%, p = .001). Approximately 50% of gynecologists from UAE- hospitals indicate they have insufficient information about UAE for appropriate counseling and 40% doubts the effectiveness of UAE. Furthermore, in the majority of gynecologists some 'urban myths' about the effectiveness and side-effects of UAE seem to persevere.

Conclusion: Adding UAE as a treatment option to the national guideline did not change the number of performed UAEs for symptomatic fibroids. It might be useful to develop an option grid in order to offer appropriate, independent counseling and encourage shared decision making.

Keywords: Annual numbers; Consent; Counselling; Heavy menstrual bleeding; Hysterectomy; Uterine artery embolization.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no competing interests, with the exception of Dr. P.N.M Lohle, who has an consultancy agreement with Boston scientific.

References

    1. de Bruijn AM, Ankum WM, Reekers JA, Birnie E, van der Kooij SM, Volkers NA, et al. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol. 2016;215(6):745 e1–745e12. doi: 10.1016/j.ajog.2016.06.051. - DOI - PubMed
    1. Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. NEnglJMed. 2007;356(4):360–370. doi: 10.1056/NEJMoa062003. - DOI - PubMed
    1. foundation. I. Hospitals in the Netherlands”. Archived on the 10th-October 2018.
    1. Garry R. The future of hysterectomy. BJOG. 2005;112(2):133–139. doi: 10.1111/j.1471-0528.2004.00431.x. - DOI - PubMed
    1. Götze R. The Changing Role of the State in the Dutch Healthcare System. TranState Working Papers 141. 2010.

LinkOut - more resources