Our Summary

This research study was aimed at comparing two treatments for uterine leiomyomas (aka fibroids) in premenopausal women: uterine artery embolization (a non-surgical procedure that blocks the blood supply to fibroids) and myomectomy (a surgical procedure to remove fibroids). The researchers were mainly interested in which treatment offered a better quality of life, but they also looked at things like how often women needed to have the procedure done again (reintervention rate), how long it took before another procedure was needed, and rates of pregnancy, miscarriage, cesarean delivery, and complications during the procedure.

The researchers found six studies that met their criteria and combined the results in a process called a meta-analysis. They found that there was little to no difference in quality of life between the two treatments. However, women who had a myomectomy had a lower chance of needing the procedure again and waited longer before needing another procedure. There was no difference in the rate of serious complications during the procedure.

In conclusion, the researchers suggest that uterine artery embolization may lead to higher rates of needing the procedure again and a shorter time before another procedure is needed, compared to myomectomy. There seems to be no difference in the rate of complications during the procedure between the two treatments. They also note that the impact of uterine artery embolization on quality of life and successful pregnancy is uncertain.

FAQs

  1. What is the difference between uterine artery embolization and myomectomy?
  2. According to the research, which procedure has a higher reintervention rate?
  3. Was there a significant difference in the rate of complications between uterine artery embolization and myomectomy?

Doctor’s Tip

One tip a doctor might give a patient considering a myomectomy is to discuss with their healthcare provider the potential benefits and risks of the procedure compared to other treatment options, such as uterine artery embolization. It’s important to have a thorough understanding of the potential outcomes and make an informed decision based on individual circumstances and preferences. Additionally, following post-operative care instructions and attending follow-up appointments can help ensure a successful recovery.

Suitable For

Patients who are typically recommended myomectomy are premenopausal women with symptomatic uterine fibroids who desire to preserve their fertility or have a desire for future pregnancies. Myomectomy is also recommended for patients with large fibroids that are causing significant symptoms such as heavy menstrual bleeding, pelvic pain, pressure symptoms, or fertility issues. Additionally, myomectomy may be recommended for patients who have failed conservative management options and are not suitable candidates for uterine artery embolization or other non-surgical treatments.

Timeline

Before myomectomy:

  1. Patient experiences symptoms of uterine fibroids such as heavy menstrual bleeding, pelvic pain, and pressure.
  2. Patient consults with a healthcare provider who recommends a myomectomy as a treatment option.
  3. Patient undergoes pre-operative evaluations and tests to determine their candidacy for surgery.
  4. Patient schedules the myomectomy procedure with a surgeon and receives instructions on pre-operative preparation.

After myomectomy:

  1. Patient undergoes the myomectomy procedure, which involves the surgical removal of fibroids from the uterus.
  2. Patient recovers in the hospital for a few days post-surgery, followed by a period of at-home recovery.
  3. Patient may experience pain, discomfort, and fatigue during the initial recovery period.
  4. Patient follows post-operative care instructions provided by the healthcare provider to aid in the healing process.
  5. Patient attends follow-up appointments with the surgeon to monitor recovery and address any concerns.
  6. Patient experiences relief from symptoms of uterine fibroids and may notice improvements in quality of life.
  7. Patient may have a lower chance of needing a repeat procedure compared to other treatment options.
  8. Patient may have a longer period of time before needing another procedure, compared to alternative treatments.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy include:

  1. What is myomectomy and how is it different from other treatments for uterine fibroids?
  2. What are the potential risks and complications associated with myomectomy?
  3. How long is the recovery period after a myomectomy and what can I expect during this time?
  4. Will my fertility be affected by having a myomectomy? What are the chances of successful pregnancy after the procedure?
  5. How likely is it that I will need to have the procedure again in the future?
  6. Are there any alternative treatments to myomectomy that I should consider?
  7. How experienced are you in performing myomectomies and what is your success rate with this procedure?
  8. Are there any specific precautions I should take before or after the procedure to ensure the best outcome?
  9. What is the typical timeline for follow-up appointments and monitoring after a myomectomy?
  10. Can you provide me with any resources or information to help me better understand myomectomy and make an informed decision about my treatment options?

Reference

Authors: Tzanis AA, Antoniou SA, Gkegkes ID, Iavazzo C. Journal: Am J Obstet Gynecol. 2024 Aug;231(2):187-195.e1. doi: 10.1016/j.ajog.2024.01.014. Epub 2024 Jan 26. PMID: 38280434