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 uterine-sparing treatment option for patients with uterine fibroids that can be performed abdominally, laparoscopically (with or without robotic assistance), and by hysteroscopy. Quality of life 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. Study Design Comparing Options for Management: Patient-centered Results for Uterine Fibroids (Compare-UF) is a prospective nationwide fibroid registry study 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 post-procedure questionnaire scheduled between 6 and 12 weeks after surgery. Health-related quality of life outcomes, such as pain, anxiety, and return to usual activities 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 done 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 1,206 women from 8 Compare-UF sites underwent myomectomy (338 hysteroscopic, 519 laparoscopic, 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 (IQR 0-14 days) for hysteroscopic myomectomy, 21 days (14-28 days) for laparoscopic myomectomy, and 28 days (IQR 14-35 days) for abdominal myomectomy. After propensity adjustment, quality of life outcomes in the laparoscopic and abdominal myomectomy groups were similar except 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 ( IQR14.0-28.0 for laparoscopic versus (IQR14.0-35.0 for abdominal, p Conclusion Women who underwent myomectomy had substantial improvement in health-related quality of life, regardless of route of myomectomy. After propensity weighting, abdominal myomectomy was associated with a nearly 2-week longer time to return to work than laparoscopic myomectomy.