Women of reproductive age with symptomatic fibroids experience significantly improved quality of life and significantly reduced symptoms following treatment with uterine fibroid embolization (UFE), a recent study reports. Published in Cardiovascular and Interventional Radiology (CVIR) Endovascular, the authors also conclude that functional uterine contractility seems to have a positive impact on quality of life and sexual function in this population.
While changes in uterine contractility pattern after UFE have already been assigned by cine magnetic resonance imaging (MRI), the impact of these changes had not been evaluated previous to this study. Lead author Vinicius Adami Vayego Fornazari (Universidade Federal de São Paulo, São Paulo, Brazil) and colleagues therefore set out to investigate the impact of uterine contractility on the quality of life of women undergoing UFE, measured by the Uterine Fibroid Symptom and Quality of Life questionnaire. The questionnaire, they say, is “a validated tool for measuring patient-reported symptoms and documenting clinical outcomes from surgical and interventional procedures.”
Whilst UFE is recognised as a Level A treatment option for managing leiomyomas in carefully selected patients, Fornazari et al claim that the procedure’s use for women of reproductive age “is still controversial”, and that the impact of fibroids on infertility is “not yet clear”. The majority of patients who wish to become pregnant therefore opt for a myomectomy, though there have been some studies that demonstrate successful pregnancies post-UFE. “One of the hypotheses for the association between fibroids and infertility,” the study authors write, “is alteration of uterine contractility.”
Uterine contractions act to eliminate peeling endometrium during the menstrual period, and also have various functionalities relating to pregnancy maintenance and fertility. However, these contractions are also implicated in dysmenorrhea (menstrual cramps). It has been hypothesised that fibroids could alter uterine contractility and functionality, Fornazari and colleagues write.
The present study supports this theory: half of the 26 patients prospectively included in the study experienced positive changes in their uterine contractility pattern following UFE. These patients were classified as group A during analysis. However, in a significant minority (38%) of patients, the uterine contractility pattern was unchanged after the procedure. These patients made up group B. Three patients (11%) lost uterine contractility after the procedure, and were categorised as group C.
The study investigators gave each of the 26 patients a questionnaire at their first MRI scan, which varied from 30 to seven days prior to undergoing UFE. All patients were then given the questionnaire again at their one-year follow-up consultation. Fornazari et al then analysed the survey results according to change in contractility from baseline after UFE (whether the patients were group A, B, or C).
All UFE patients presented a statistically significant reduction in mean symptom score, as well as a statistically significant increase in mean quality of life scores. Quality of life scores included worry, activity, energy, self-control, self-confidence, and sexual function.
Breaking this down by group: in those patients with an unchanged uterine contractility pattern (group A), the authors report a statistically significant reduction in mean symptom score, and an increase in the mean score of all quality of life scores, with the exception of the sexual function subscale (p=0.3232). For the 50% of patients with a favourably modified uterine contractility pattern (group B), there was a statistically significant reduction in mean symptom score, and an increase in mean quality of life score. As there were only three patients with loss of uterine contractility after UFE (in group C), no analysis could be performed.
Form these results, Fornazari et al surmise that “The significant improvement of uterine contractility and simultaneous improvement of quality of life these patients experienced after UFE suggests that uterine contractility may have a positive impact on quality of life.”
A comparative analysis between groups A and B found that, before UFE, group A had a higher sexual function score. As sexual function is a quality of life metric, the higher the score, the better. In patients with no change in uterine contractility pattern after UFE, there was also no significant change in sexual function. For patients who did experience a beneficial change in uterine contractility pattern (group B), however, there was a statistically significant increase in sexual function score. Fornazari and colleagues say that, in their previously published work, they “did not identify statistically significant variables that could be correlated to this data. In this study, the only potentially relevant variable that could be associated with a low interference in sexual function, both before and after UFE, is the fact that this group experienced no change in uterine peristalsis.”
However, Fornazari et al do note that their sample size was small, and say that additional studies are required to confirm or denounce their finding that functional uterine contractility has a positive impact on fertility and quality of life.