A Comparative Analysis of Health-Related Quality of Life 1 Year Following Myomectomy or Uterine Artery Embolization: Findings from the COMPARE-UF Registry

Raymond M Anchan; Daniel Wojdyla; Pietro Bortoletto; Kathryn Terry; Emily Disler; Ankrish Milne; Antonio Gargiulo; John Petrozza; Olga Brook; Serene Srouji; Cynthia C Morton; James Greenberg; Ganesa Wegienka; Elizabeth A Stewart; Wanda K Nicholson; Laine Thomas; Sateria Venable; Shannon Laughlin-Tommaso; Michael P Diamond; G Larry Maxwell; Erica E Marsh; Evan R Myers; Anissa I Vines; Lauren A Wise; Kedra Wallace; Vanessa L Jacoby; James B Spies

doi:10.1089/jwh.2022.0133

A Comparative Analysis of Health-Related Quality of Life 1 Year Following Myomectomy or Uterine Artery Embolization: Findings from the COMPARE-UF Registry

J Womens Health (Larchmt). 2023 Apr;32(4):423-433. doi: 10.1089/jwh.2022.0133. Epub 2023 Jan 13.

Authors

Raymond M Anchan¹, Daniel Wojdyla², Pietro Bortoletto³, Kathryn Terry¹, Emily Disler¹, Ankrish Milne¹, Antonio Gargiulo¹, John Petrozza⁴, Olga Brook⁵, Serene Srouji¹, Cynthia C Morton^{1

6

7

8}, James Greenberg¹, Ganesa Wegienka⁹, Elizabeth A Stewart¹⁰, Wanda K Nicholson¹¹, Laine Thomas^{2

12}, Sateria Venable¹³, Shannon Laughlin-Tommaso^{9

14}, Michael P Diamond¹⁵, G Larry Maxwell¹⁶, Erica E Marsh¹⁷, Evan R Myers¹⁸, Anissa I Vines¹⁹, Lauren A Wise²⁰, Kedra Wallace²¹, Vanessa L Jacoby²², James B Spies²³

Affiliations

¹ Department of Obstetrics, Gynecology, and Reproductive Biology, Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
³ The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York, USA.
⁴ Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁶ Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
⁸ Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
⁹ Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.
¹⁰ Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Department of Obstetrics and Gynecology, Center for Women's Health Research, and Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, USA.
¹² Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
¹³ The Fibroid Foundation, Bethesda, Maryland, USA.
¹⁴ Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
¹⁵ Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia, USA.
¹⁶ Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, Virginia, USA.
¹⁷ Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
¹⁸ Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁹ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
²⁰ Slone Epidemiology Center, Boston University School of Public Health, Boston, Massachusetts, USA.
²¹ Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
²² Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California, USA.
²³ Department of Radiology, Georgetown University School of Medicine, Washington, District of Columbia, USA.

Abstract

Objective: To compare 12-month post-treatment health-related quality of life (HR-QoL) and symptom severity (SS) changes among patients with symptomatic uterine fibroids (SUF) not seeking fertility and undergo a hysterectomy, abdominal myomectomy (AM), or uterine artery embolization (UAE). Materials and Methods: The Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF) Registry is a multi-institutional prospective observational cohort study of patients treated for SUF. A subset of 1465 women 31-45 years of age, who underwent either hysterectomy (n = 741), AM (n = 446), or UAE (n = 155) were included in this analysis. Demographics, fibroid history, and symptoms were obtained by baseline questionnaires and at 1 year post-treatment. Results were stratified by all treatments and propensity score weighting to adjust for differences in baseline characteristics. Results: Women undergoing UAE reported the lowest baseline HR-QoL and highest SS scores (mean = 40.6 [standard deviation (SD) = 23.8]; 62.3 [SD = 24.2]) followed by hysterectomy (44.3 [24.3]; 59.8 [SD = 24.1]). At 12 months, women who underwent a hysterectomy experienced the largest change in both HR-QoL (48.7 [26.2]) and SS (51.9 [25.6]) followed by other uterine-sparing treatments. Propensity score weighting revealed all treatments produced substantial improvement, with hysterectomy patients reporting the highest HR-QoL score (92.0 [17.8]) compared with myomectomy (86.7 [17.2]) and UAE (82.6 [21.5]) (p < 0.0001). Similarly, hysterectomy patients reported the lowest SS scores (8.2 [15.1]) compared with myomectomy (16.5 [15.1]) and UAE (19.6 [17.5]) (p < 0.0001). Conclusion: All procedures showed improvement in HR-QoL and reduction in SS score at 12 months, hysterectomy showing maximum improvement. Of importance, at 12 months, patients who underwent either a myomectomy or UAE reported comparable symptom relief and HR-QoL. Clinicaltrials.Gov Identifier: NCT02260752.

Keywords: hysterectomy; myomectomy; quality of life; uterine artery embolization; uterine fibroids.

Publication types

Comparative Study
Observational Study
Research Support, U.S. Gov't, P.H.S.
Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Hysterectomy
Leiomyoma* / surgery
Prospective Studies
Quality of Life*
Registries
Treatment Outcome
Uterine Artery Embolization* / psychology
Uterine Myomectomy* / psychology
Uterine Neoplasms* / surgery

Associated data

ClinicalTrials.gov/NCT02260752

Grants and funding

P50 HS023418/HS/AHRQ HHS/United States