This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Fibroids are growths of muscle and fibrous tissue that develop in or around the womb. They can cause pain but are not cancer. Research found that women who had surgery to remove fibroids needed fewer procedures over the next 5 years than those who had blood vessels blocked (uterine artery embolisation or UAE).
Before this study, it was unclear which of the 2 procedures was better in the long-term. Researchers analysed the records of 15,000 women who were treated between 2010 and 2015 and followed up for at least 5 years.
Women who had UAE were twice as likely to have a hysterectomy (surgical removal of the womb) than those who had surgical removal of fibroids. They were also substantially more likely to need further procedures relating to fibroids than women who had surgery. Older women had fewer additional procedures, but more research is needed to confirm this.
The findings will allow doctors to counsel women considering treatment for fibroids to help them make an informed decision.
The issue: should I have surgery to remove fibroids, or uterine artery embolisation?
Most (2 in 3) women develop fibroids in their lifetime. Many do not experience symptoms, but some have heavy or painful periods, abdominal or lower back pain. A few women have difficulty becoming pregnant or have complications in pregnancy.
The most common treatment for fibroids is a hysterectomy. This is a major operation and will prevent future pregnancies. Many women opt for treatments that preserve their womb such as surgical removal of fibroids (myomectomy) or blocking the blood vessels that supply the fibroids (UAE). Guidelines from the National Institute for Health and Care Excellence (NICE) advise against UAE among women who wish to become pregnant because it may negatively affect fertility or future pregnancies. Though women may choose UAE instead of surgical removal because it is linked with a shorter recovery, for example. The size, number and position of fibroids will determine whether surgical removal is possible.
Some small studies suggest that quality of life and patient satisfaction are similar following surgical fibroid removal and UAE in the short-term (less than 5 years). However, other short-term studies suggest that women who have UAE require more procedures (such as hysterectomy) to manage fibroids when they reoccur, than women who have surgical removal of fibroids.
Researchers investigated the number of future interventions in the 5 years (or more) after these treatments.
The study was based on the records of women in England who had fibroids surgically removed (9,443 women) or UAE (6,224 women) between 2010 – 2015. Participants’ average age was 41 and almost 1 in 3 (30%) were Black. Women were followed up for at least 5 years (7 years on average).
The main outcome of the study was the number of women who needed a hysterectomy or another fibroid procedure (including endometrial ablation) after their initial procedure.
In the 5 years or more after their treatment, women who had UAE:
- were more than twice as likely to have a hysterectomy as those who had fibroid removal
- had a greater risk (44% increase) of having further fibroid procedures than women who had fibroid removal.
In the short-term, women who had UAE were discharged sooner from hospital (after 1 day, on average) than those who had fibroid removal (after 3 days). However, more women who had UAE had been admitted to hospital in the 30 days after discharge.
Age had an impact on whether women who had UAE needed further treatment: more younger women (aged 18 – 30 years) needed another fibroid treatment (39%) compared with women over 45 (8%). For surgical removal of fibroids, a similar number of younger women (11%) had further treatments compared with older women (8%).
After either treatment, the risk of having a hysterectomy was twice as high in North-East England compared with Yorkshire, the East of England and London. There was also regional variation in the type of surgery for fibroid removal. Fewest keyhole procedures were carried out in the East Midlands.
Why is this important?
In the 5 years after treatment, women who had UAE were more likely to have a hysterectomy or other further procedures than those who had surgical fibroid removal. These findings will allow doctors to counsel women about the long-term risks and benefits of each treatment and aid shared decision-making.
Older women had fewer procedures following UAE than younger women. This suggests that UAE may have less durable effects in younger women. The researchers say this could be due to differences in the blood vessels that supply fibroids (or in the fibroids themselves). Alternatively, more young women might opt for additional procedures in order to reduce fibroid growth and improve their chances of having a child. However, the study could not examine women's preferences. More research is needed to understand this finding.
The authors call for a patient registry to be set up in the UK to monitor outcomes (such as quality of life and pregnancy outcomes) after fibroid treatment. They also suggest creating guidelines on the management of fibroids in England.
Fibroids are known to be more common in Black women, yet few UK studies have looked at the impact of ethnicity on treatment outcomes. The researchers are now investigating the impact of ethnicity and social deprivation on treatment outcomes for fibroids.
You may be interested to read
This Alert is based on: Amoah A and Quinn SD. Uterine-preserving treatments or hysterectomy reintervention after myomectomy or uterine artery embolisation: A retrospective cohort study of long-term outcomes. British Journal of Gynaecology 2023; 30: 823 – 831.
Information from the British Fibroid Trust, a patient advocacy group for women with fibroids.
A video from the BBC in which a woman views a 3D representation of her fibroids.
Information on taking part in NIHR studies involving fibroids.
A study exploring outcomes following surgical fibroid removal: Manyonda I, and others. Uterine-Artery Embolization or Myomectomy for Uterine Fibroids. New England Journal of Medicine 2020; 383: 440 – 451.
Funding: this study was funded by the NIHR Imperial Biomedical Research Centre.
Conflicts of Interest: none declared.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.