Women under 40 years old who undergo uterine fibroid embolization (UFE) are highly likely to experience symptom recurrence before menopause and may require additional procedures, yet report high levels of treatment satisfaction.
These were the key takeaways of a new long-term retrospective survey across two institutions led by Elisabeth R Seyferth (Perelman School of Medicine, Philadelphia, USA) et al. Published in the journal CardioVascular and Interventional Radiology (CVIR), the authors identified 976 women who underwent UFE between 2001–2021, 173 of whom were younger than 40 at the time of treatment; 80 of 173 participated in the survey.
Median age at embolization was 37.2 years and when surveyed was 52.7 years. Among respondents, 70% (56/80) and 18.8% (15/80) of patients reported “a lot” or “a little” symptom improvement, respectively, in the first six months after UFE; 11.2% (9/80) reported no change. Of those with improvement, symptoms returned in 57.7% (41/71) of patients, with median time to recurrence of 11 years. Freedom from recurrence of symptoms was 95.8% at one year, 67.6% at five years, and 50.7% at 10 years. Freedom from hysterectomy for recurrent symptoms was 98.6% at one year, 84.5% at five years, and 71.8% at 10 years. Patient satisfaction having received UFE was a median of 5 on a scale of 1–5 (5=very satisfied).
Seyferth and colleagues report that 12.5% of women attempted to become pregnant after UFE. Of these, 40% (4/10) had a successful live birth. In their discussion, the authors note that, although fertility rates for UFE remain limited, this finding is comparable to the 2008 trial by Michal Mara (Charles University, Prague, Czech Republic) et al which reported a labour rate of 48% among patients who attempted to become pregnant after myomectomy.
The authors note that most patients endorsed high satisfaction with UFE despite high rates of symptom recurrence, with multiple patients choosing “very satisfied”, stating that UFE had “changed their life”. Notably, while some patients mentioned that they were counselled that symptoms may recur, others felt that they were not told of that possibility and therefore chose a lower satisfaction score. Although this finding emphasises the importance of appropriate pre-procedure counselling across centres, Seyferth and colleagues maintain that “satisfaction following UFE remained high, with many experiencing years of symptom relief”.
