Long-Term Quality of Life Assessment Among Patients Undergoing Uterine Fibroid Embolization

Martin Popovic; Dominik Berzaczy; Stefan Puchner; Andreas Zadina; Johannes Lammer; Robert A. Bucek

Disclosures

Am J Roentgenol. 2009;193(1):267-271. 

In This Article

Results

Thirty-nine of the 53 patients (73.6%) who responded to the QOL questionnaire reported in 2006 participated again. The other 14 patients were lost to follow-up. The median follow-up period from intervention to completion of the survey was 7.0 years (IQR, 1.5 years). The mean age of the patients was 49.3 ± 7.1 years (range, 35.4-66.4 years). In short, the most important subjective reasons for deciding to undergo UFE were preservation of the uterus for 34 patients (87.2%), a strong desire for children for four patients, and fear of surgery for one patient. For six patients, the definite treatment was hysterectomy. Two patients underwent surgical removal of the uterus 1.0 year after UFE, and one patient each 2.1, 2.9, 3.3, and 5.7 years after UFE. These six patients were excluded from subsequent statistical analysis to allow interpretation of UFE effects only.

Bleeding

Before intervention, 29 of the 33 patients (87.9%) had bleeding that included menorrhagia, dysmenorrhea, and metrorrhagia (Table 1). The median impairment score for these difficulties was 7 (IQR, 5.4) (Fig. 1). Data at midterm and long-term follow-up evaluations were similar in that two and three women, respectively, continued to experience bleeding. This finding represents relative frequency reductions of 93.1% for midterm and 89.7% for long-term follow-up compared with the status before intervention. Symptoms of menorrhagia were reported to have continued, whereas difficulties with metrorrhagia had occurred recently. The median impairment score for these problems was 0 (IQR, 0), 84.8% of patients scoring the symptom 0 in the midterm and 81.8% scoring it 0 in the long term. This finding denotes sustained and significant improvement compared with the situation before intervention (p < 0.001).

Fig. 1

Graph shows bleeding impairment score in direct comparison (n = 33) before uterine fibroid embolization (UFE) and in midterm and long term after embolization.

Pain and Bulk-Related Symptoms

Pain and diffuse bulk-related symptoms were reported by 19 patients (57.6%) before embolization. The foci of pain were the pelvic region, the back, and the epigastric region (Table 2). The median pain score was 5 (IQR, 7) (Fig. 2). At midterm and long-term follow-up, four patients continued to experience pain. This finding corresponds to a relative frequency reduction of 78.9% for both follow-up periods. Midterm and long-term follow-up evaluation for symptoms revealed that one and two patients, respectively, reported that they continued to have bulk-related symptoms. This finding corresponds to relative frequency reductions of 94.7% in the midterm and 89.5% in the long-term assessment. Symptoms of pain and bulk-related problems were reported to continue. The median pain score for both follow-up periods was 0 (IQRmidterm, 0; IQRlong term, 1), 29 patients (87.9%) reporting a score of 0 in the midterm and 21 patients (63.6%) reporting a score of 0 in the long term (both p < 0.001 compared with the assessment before intervention).

Fig. 2

Graph shows pain impairment score in direct comparison (n = 33) before uterine fibroid embolization (UFE) and in midterm and long term after embolization.

Other Fibroid-Related Symptoms

Before intervention, seven patients reported pain during their usual sexual activity. Twelve patients (36.4%) considered themselves less productive than earlier in life, 16 patients (48.5%) had problems exercising, 10 patients (30.3%) believed they had lost control of their lives, and 16 patients (48.5%) considered themselves heavily restricted in their daily lives. The median QOL score was 4.5 (IQR, 5.25).

After intervention, one patient reported that she felt less productive at midterm assessment (relative frequency reduction, 91.7%), and three women reported diminished productivity at long-term follow-up (relative frequency reduction, 75%). One patient (relative frequency reduction, 93.8%) and five patients (relative frequency reduction, 68.8%) reported problems exercising at midterm and long-term follow-up assessments, respectively. At midterm assessment, one patient reported feeling loss of control over her life (relative frequency reduction, 90.0%), and one patient reported feeling restricted in daily life (relative frequency reduction, 93.8%). The long-term evaluation feedback showed that two patients felt likewise regarding loss of control (relative frequency reduction, 80.0%) and the feeling of restriction in daily life (relative frequency reduction, 87.5%). For both patients, the midterm and long-term median QOL scores improved significantly to 9 (IQRmidterm, 1.8; IQRlong-term, 3; p < 0.001).

Reproduction in the Long Term

After intervention, two patients gave birth to healthy infants at term. Four women continued to have problems conceiving, and one had a miscarriage. Five patients had amenorrhea. Four of the five were older than 50 years, and one patient was 42 years old at follow-up.

Long-Term General Satisfaction

Twenty-eight of the total of 39 patients (71.8%) were content with the intervention, and five (12.8%) were disappointed. Thirty women (76.9%) would highly recommend UFE to other patients, and four patients would do so under conditional circumstances. Overall subjective QOL improved significantly in the midterm and the long term (Figs. 3 and  4).

Fig. 3

Graph shows quality-of-life (QOL) scores of 33 patients before uterine fibroid embolization (UFE) and in midterm and long term after embolization. 0 = worst QOL, 10 = best possible QOL.

Fig. 4

Graph shows developments from before uterine fibroid embolization (UFE) through midterm and long-term follow-up (n = 33).

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