Two Procedures May Yield Similar Symptom Relief for Uterine Fibroids

Laparoscopic radiofrequency ablation and myomectomy for uterine fibroids both resulted in significant and sustained improvements on symptoms and health-related quality of life (HRQOL) measures over 2 years, with between-group differences below the thresholds for minimally clinically important changes, data from a prospective cohort study showed.

In propensity-weighted models, there was a greater reduction in symptom severity scale scores in the myomectomy group compared with the radiofrequency ablation group (-33.0 vs -27.7, difference -5.27, P=0.028) and greater HRQOL improvements (34.92 vs 28.29, difference -6.62, P=0.011) over 24 months.

However, these between-group differences fell far below the thresholds for minimally clinically important changes (10 points for symptoms and 20 points for HRQOL), reported Antoinette Allen, MD, of Weill Cornell Medicine in New York City, and colleagues.

At 6 months postprocedure, those who had a myomectomy showed modestly greater improvements on multiple Uterine Fibroid Symptom and HRQOL questionnaire domains and symptoms compared with those who had radiofrequency ablation, but these did not exceed the threshold for clinical significance. By 24 months, those differences disappeared, the researchers wrote in Obstetrics & Gynecology.

“These findings suggest that both procedures provide substantial and durable improvements in symptoms and HRQOL, supporting individualized treatment selection based on patient goals, clinical characteristics, and shared decision-making,” they concluded.

“Longitudinally, they both work really, really well,” Allen told MedPage Today, “but I do think that myomectomy does have its initial advantage.”

Uterine leiomyomas, also called uterine fibroids, are benign pelvic tumors that affect 70-80% of reproductive-aged women by age 50. Black women in particular have heightened risk of fibroids, and their fibroids tend to be larger and present earlier than in white women.

“Although hysterectomy is the definitive treatment for uterine leiomyomas, it is not appropriate for individuals desiring future fertility or uterine preservation,” the authors wrote. “Moreover, hysterectomy, even with ovarian conservation, has been linked to increased long-term risks, including cardiovascular and metabolic diseases, particularly among younger women.”

This has led to an interest in less-invasive options for fibroid symptom management, including laparoscopic radiofrequency ablation and myomectomy. For the former, clinicians ablate the center of the fibroid which then shrinks over time; this is helpful for women who desire fibroid symptom management but don’t want to eliminate their option for vaginal delivery. The latter is an open or laparoscopic procedure that removes the entire fibroid; nearly all women who have a myomectomy end up having to have a cesarean delivery, Allen noted.

Few studies have compared outcomes after these two procedures and much of the existing research has been with small cohorts followed for short periods of time. This study was intended to provide insight into whether one procedure offers greater QOL improvements, the researchers said.

The multicenter prospective ULTRA study included patients at academic and community medical centers across the U.S. beginning in 2014. Participants were English- or Spanish-speaking premenopausal women ages 21 years or older with symptomatic uterine leiomyomas who were planning to undergo uterine-preserving surgical treatment (laparoscopic or abdominal myomectomy or laparoscopic radiofrequency ablation). Those who planned hysterectomy or hysteroscopic myomectomy were excluded, as were those unable to complete baseline assessments.

The study cohort was 53.0% Black, 20.2% white, 13.4% Hispanic, and 7.1% Asian. Patients had a median of two leiomyomas and substantial baseline symptom burden. Among 401 participants (mean age 39), 237 had radiofrequency ablation and 164 had myomectomy; 386 completed at least one follow-up assessment and were included in the analysis.

Participants were followed for 3 to 5 years but this analysis was restricted to the first 2 years post-op. At baseline and at 6-month intervals, participants completed questionnaires on their demographics, symptoms, and HRQOL.

The researchers noted some limitations, including the nonrandomized study design, differences in baseline leiomyoma characteristics, and that patients undergoing myomectomy tended to enter the study later than those getting radiofrequency ablation. Residual confounding may have influenced results.