Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial

Sanne M. van der Kooij, MD; Wouter J. K. Hehenkamp, MD, PhD; Nicole A. Volkers, MD, PhD; Erwin Birnie, PhD; Willem M. Ankum, MD, PhD; Jim A. Reekers, MD, PhD

OBJECTIVE: The purpose of this study was to compare clinical outcome and health related quality of life (HRQOL) 5 years after uterine artery embolization (UAE) or hysterectomy in the treatment of menorrhagia caused by uterine fibroids.

STUDY DESIGN: Patients with symptomatic uterine fibroids who were eligible for hysterectomy were assigned randomly 1:1 to hysterectomy or UAE. Endpoints after 5 years were reintervention rates, menorrhagia, and HRQOL measures that were assessed by validated questionnaires.

RESULTS: Patients were assigned randomly to UAE (n88) or hysterectomy (n  89). Five years after treatment 23 of 81 UAE patients (28.4%) had undergone a hysterectomy because of insufficient improvement of complaints (24.7% after successful UAE). HRQOL measures improved significantly and remained stable until the 5-year follow-up evaluation, with no differences between the groups. UAE had a positive effect both on urinary and defecation function.

CONCLUSION: UAE is a well-established alternative to hysterectomy about which patients should be counseled.