Is uterine artery embolization a safe and effective alternative treatment in women with symptomatic fibroids?
Uterine fibroids (benign tumours) can cause varied symptoms such as heavy bleeding, pain and reduced likelihood of pregnancy. Surgery (hysterectomy or myomectomy) has traditionally been the main treatment option but it carries a risk of complications. Uterine artery embolization (UAE) is a newer treatment option which blocks the blood supply to the womb and thus shrinks the fibroids and reduces their effects. The evidence was current to April 2014.
There were seven studies included in the review (793 participants). Three of these compared UAE with hysterectomy, two studies compared UAE with myomectomy, and another two with hysterectomy or myomectomy. The studies differed in their outcomes and length of follow-up.
With regard to patient satisfaction rates, our findings were consistent with satisfaction rates being up to 41% lower or up to 48% higher with UAE compared to surgery within 24 months of having the procedure. Findings on satisfaction rates were also inconclusive at five years of follow-up.
There was very low quality evidence to suggest that fertility outcomes (live birth and pregnancy) may be better after myomectomy than after UAE, but this evidence was based on a small selected subgroup and should be regarded with extreme caution. The UAE group had a shorter hospital stay and a more rapid return to daily activities. With regards to safety, the evidence on major complications was inconclusive and consistent with benefit or harm, or no difference, from either intervention. However, the risk of minor complications was higher after UAE. Moreover, there was a higher likelihood of needing another surgical intervention after UAE, at two year and at five year follow-up. If we assumed that 7% of women will require further surgery within two years of hysterectomy or myomectomy, between 15% and 32% will require further surgery within two years of UAE. Therefore, it appears that while UAE is a safe option with an earlier initial recovery, it does carry a higher risk of minor complications and the need for further surgery later on.
Quality of the evidence:
The quality of the evidence varied from very low for live birth, to moderate for satisfaction ratings and for most safety outcomes. The main limitations in the evidence were serious imprecision, failure to clearly report methods, and lack of blinding for subjective outcomes.