Short-Term Quality of Life After Myomectomy for Uterine Fibroids From the Compare-UF Fibroid Registry

Abstract

BACKGROUND: Uterine fibroids may decrease quality of life in a significant proportion of affected women. Myomectomy offers a uterinesparing treatment option for patients with uterine fibroids that can be performed abdominally, laparoscopically (with or without robotic assistance), and hysteroscopically. Quality of life information using validated measures for different myomectomy routes, especially hysteroscopic myomectomy, is limited. OBJECTIVE: To compare women's perception of their short-term health-related quality of life measures and reported time to return to usual activities and return to work for different routes of myomectomy. MATERIALS AND METHODS: Comparing Options for Management: Patient-centered Results for Uterine Fibroids (COMPARE-UF) is a prospective nationwide fibroid registry that enrolled premenopausal women seeking treatment for uterine fibroids at 8 clinical sites. For this analysis, we included women undergoing hysteroscopic, abdominal, or laparoscopic myomectomy who completed the postprocedure questionnaire scheduled between 6 and 12 weeks after surgery. Health-related quality of life outcomes, such as pain, anxiety, and return to usual activitie, were assessed for each route. The hysteroscopic myomectomy group had large differences in demographics, fibroid number, and uterine size compared to the other groups; thus, a direct comparison of quality of life measures was performed only for abdominal and laparoscopic approaches after propensity weighting. Propensity weighting was done using 24 variables that included demographics, quality of life baseline measures, and fibroid and uterine measurements. RESULTS: A total of 1206 women from 8 COMPARE-UF sites underwent myomectomy (338 hysteroscopic, 519 laparoscopic, and 349 abdominal). All women had substantial improvement in short-term health-related quality of life and symptom severity scores, which was not different among groups. Average symptom severity scores decreased about 30 points in each group. Return to usual activities averaged 0 days (interquartile range, 0e14 days) for hysteroscopic myomectomy, 21 days (interquartile range, 14e28 days) for laparoscopic myomectomy, and 28 days (interquartile range, 14e35 days) for abdominal myomectomy. After propensity adjustment, quality of life outcomes in the laparoscopic and abdominal myomectomy groups were similar except for more anxiety in the laparoscopic myomectomy group and slightly more pain in the abdominal myomectomy group. After propensity weighting, return to usual activities favored laparoscopic compared to abdominal procedures; median time was the same at 21 days, but the highest quartile of women in the abdominal group needed an additional week of recovery (interquartile range,14.0e28.0 for laparoscopic versus 14.0e35.0 for abdominal, P < .01). Time to return to work was also longer in the abdominal arm (median, 22 days; interquartile range, 14e40 days, versus median, 42; interquartile range, 27e56). CONCLUSION: Women who underwent myomectomy had substantial improvement in health-rel...

Efficacy and Safety of the Two Ayurveda Drug Regimens in Uterine Fibroids: A Randomized Single-Blind Clinical Trial

“…Demographic data were not significantly variable in the three arms (Table 2). erefore, a comparable study can be made in this research' findings where most of such other studies were unable to perform [15]. e results indicated a reduction of the fibroid volume at 12 th week in both experimental groups (arm I mean difference: Evidence-Based Complementary and Alternative Medicine 13.81 cm 3 ; arm II mean difference: 0.38 cm 3 ) which was significant in arm II (P > 0.05) (Table 3).…”

Black Women Are More Likely Than White Women to Schedule a Uterine-Sparing Treatment for Leiomyomas

“…It may reflect distrust as a result of historic racial inequities in forced sterilization and hysterectomy. 6,17,18 Choice of nonsurgical alternatives is also likely influenced by more rapid recovery than with a hysterectomy 16 and by the patient's inability to take extended time off from work or need to manage child or elder care responsi-bilities. A woman's decision to keep her uterus may reflect her desire to maintain the possibility of childbearing, regardless of her actual fertility.…”

“…Variables considered as potential confounders were those we have previously used in our analyses. 15,16 These variables include age, insurance type (public, private, or military), financial toxicity (rather than income and education), time since being diagnosed with UF, body mass index (BMI) (continuous kg/m 2 ), current use of birth control (any birth control pill, patch, ring, implant, intrauterine device, or injectable), whether the participant had any prior procedures for UF treatment, discomfort during intercourse, whether the participant's menstrual periods were ''regular'' or ''predictable,'' frequent urination, previous number of pregnancies, current marijuana use, calculated total fibroid volume, calculated uterine volume, and number of fibroids identified. Indicator variables were also created for self-report of each of the following health conditions (comorbidities): high blood pressure, diabetes, asthma, thyroid problems, and blood clots in the legs or lungs.…”

Miomectomía laparoscópica asistida por robot, cirugía laparoscópica y laparotomía: Análisis de resultados

“…8 En este mismo sentido, con un equipo quirúrgico que opera en forma frecuente, la miomectomía robótica es superior frente a la miomectomía laparoscópica convencional, incluso en el rubro referente al costo/beneficio. 9 Y es que si se cuenta con un equipo formado por anestesiólogos, médico cirujanos, enfermería y paramédicos que de forma regular realizan este tipo de abordaje robótico, se logra eficiencia, economía, menores tiempos quirúrgicos y los resultados son adecuados. Aun así, como lo menciona Wu, se necesitan más estudios para determinar qué pacientes son los que se beneficiarían enormemente por medio de un abordaje robótico, tanto en términos de resultados en la paciente como de rentabilidad.…”