Life Quality in Premenopausal Women after Embolization of Uterine Myomas

Abstract

Objectives: Fibroids cause significant morbidity and are the most common indication for hysterectomies worldwide, delimiting a major public health problem. Uterine artery embolization (UAE) is an alternative therapy to surgical treatment of symptomatic fibroids; it has satisfactory long-time results and is no longer considered investigational for the treatment of symptomatic fibroids. This study was undertaken to evaluate changes in fibroid specific symptom severity and health-related quality of life (HRQOL) after UAE and to optimize the assessment of safety and outcomes measures for participants who receive UAE to objective compare UAE and surgical alternatives for therapy of symptomatic fibroids. Study design: The analysis was based on questionnaires completed by 270 pre-menopausal females with a mean age of 42 years (range, 38-50 years) who underwent UAE for uterine leiomyomas and/or adenomyosis from November 2013 through December 2019. Only symptomatic women were selected whose symptoms were not improving with medication and who did not wish to have children. The primary outcome measure was a change in fibroid symptoms and HRQOL (health related quality of life) after UAE. Secondary outcomes included the decrease in uterine volume after UAE. Results: Questionnaires were completed by 270 women (100%) at a mean of 12.1 months from UAE. The median follow-up period was two years. Uterine fibroid embolization led to a shrinkage at three months for the 90% of the participants. A reduction of bleeding symptoms, pain and bulk-related symptoms was observed in 89.7%, 88.9%, and 89.5% of the patients, respectively. In the long term, there was no significant difference in parameters assessed compared with the midterm follow-up findings. A total of 6 patients (2.3%) underwent fractional curettage an average of 32.1 months after intervention due to necrotic changes in submucosal fibroids. All participants continued to be satisfied with the intervention, and 240 patients (88.9%) answered that they would recommend uterine fibroid embolization to other patients. Conclusions: Women who undergo UAE have a significant decrease in symptom severity and increase in HRQOL which is associated with high levels of satisfaction with the procedure (even when subsequent therapies are pursued).

Keywords: life quality; premenopausal women; uterine artery embolization; uterine fibroids.

Figure 1

Bleeding abnormalities: Pre-embolization: Bleeding abnormalities during menstruation was reported in about 260 women out of a total 270 women. 1 Month postembolization from 260 women 60 report bleeding abnormalities during menstruation. 3 Months postembolization from 260 women only 10 participants report bleeding abnormalities during menstruation. 6 Months postembolization from 260 women 0 participants report bleeding abnormalities during menstruation. 9 Months postembolization from 260 women 0 participants report bleeding abnormalities during menstruation. 12 Months postembolization from 260 women 0 participants report bleeding abnormalities during menstruation.

Figure 2

Blood clots: Pre-embolization 80 from 270 participants reported passing blood clots during menstruation. 1 Month postembolization 70 from 80 participants reported passing blood clots during menstruation. 3 Months postembolization only 2 from participants reported passing blood clots postembolization, which they have submucosal fibroma and they under-went in fractional curettage three months postembolization. 6 Months postembolization 0 from 80 participants reported passing blood clots during menstruation. 9 Months postembolization 0 from 80 participants reported passing blood clots during menstruation. 12 Months postembolization 0 from 80 participants reported passing blood clots during menstruation.

Figure 3

The fluctuation during the menstrual cycle: Pre-embolization 60 from 270 participants reported fluctuation during the menstrual cycle. 1 Month 30 from 60 participants reported unchanged fluctuation during the menstrual cycle. 3 Months 20 from 60 participants reported fluctuation during the menstrual cycle. 6 Months 0 from 60 participants reported unchanged, but significantly reduced fluctuation during the menstrual cycle. 9 Months 0 from 60 participants reported unchanged flatulence, but significantly reduced pelvic floor heaviness, frequent urination during the menstruation’s day. 12 Months0 from 60 participants reported unchanged flatulence, but signifi-cantly reduced fluctuation during the menstrual cycle.

Figure 4

Presence or absence of amenorrhea: 1 Month 10 from 270 participants reported presence of amenorrhea after em-bolization aged greater than 45 years. 3 Months 0 from 10 participants reported presence of amenorrhea after embolization. 6 Months 0 from 10 participants reported presence of amenorrhea after embolization. 9 Months 0 from 10 participants reported presence of amenorrhea after embolization. 12 Months 0 from 10 participants reported presence of amenorrhea after embolization.

Figure 5

Dysmenorrhea and dyspareunia: Pre-embolization 110 from 270 participants reported dysmenorrhea and dyspareunia. 1 Month 60 from 110 participants reported decrease in dysmenorrhea and dyspareunia. 3 Months 90 from 110 participants reported decrease in dysmenorrhea and dyspareunia. 6 Months 110 from 110 participants reported decrease in dysmenorrhea and dyspareunia. 9 Months 110 from 110 participants reported decrease in dysmenorrhea and dyspareunia. 12 Months 110 from 110 participants reported decrease in dysmenorrhea and dyspareunia.

Figure 6

Anxious about the unpredictable onset or duration of your periods: Pre-embolization 80 from 270 participants reported anxiety about the unpre-dictable onset or duration of their periods. 1 Month 50 from 80 participants reported anxiety about the unpredictable onset or duration of their periods. 3 Months 10 from 80 participants reported anxiety about the unpredictable onset or duration of their periods. 6 Months 0 from 80 participants reported anxiety about the unpredictable onset or duration of their periods. 9 Months 0 from 80 participants reported anxiety about the unpredictable onset or duration of their periods. 12 Months 0 from 80 participants reported anxiety about the unpredictable onset or duration of their periods.

Figure 7

Sexual activity: Pre-embolization 125 from 270 participants reported having problems with their sexual activity. 1 Month 75 from 125 participants reported having problems with their sexual activity. 3 Months 30 from 125 participants reported having problems with their sexual activity. 6 Months 0 from 125 participants reported having problems with their sexual activity. 9 Months 0 from 125 participants reported having problems with their sexual activity. 12 Months 0 from 125 participants reported having problems with their sexual activity.

Figure 8

Pain, infection:. Pre-embolization 125 from 270 participants reported presence of pain. 1 Month 25 from 125 participants reported presence of pain, infection. 3 Months 5 from 125 participants reported presence of pain. 6 Months 0 from 125 participants reported presence of pain. 9 Months 0 from 125 participants reported presence of pain. 12 Months 0 from 125 participants reported presence of pain.

Figure 9

Pressure or tightness in pelvic area: Pre-embolization 125 from 270 participants reported feeling of pressure or tightness in their pelvic area. 1 Month 70 from 125 participants reported feeling of pressure or tightness in their pelvic area. 3 Months 30 from 125 felt pressure or tightness in their pelvic area. 6 Months 0 from 125 felt pressure or tightness in their pelvic area. 9 Months 0 from 125 felt pressure or tightness in their pelvic area. 12 Months 0 from 125 felt pressure or tightness in their pelvic area.

Figure 10

Libido: Pre-embolization 135 from 270 participants reported reduction in their libido or prevention from having sex. 1 Month 70 from 135 participants reported reduction in their libido or prevention from having sex. 3 Months 30 from 135 participants reported reduction in their libido or prevention from having sex. 6 Months 0 from 135 participants reported reduction in their libido or prevention from having sex. 9 Months 0 from 135 participants reported reduction in their libido or pre-vention from having sex. 12 Months 0 from 135 participants reported reduction in their libido or prevention from having sex.