Short-term Health-Related Quality of Life After Hysterectomy Compared With Myomectomy for Symptomatic Leiomyomas

One or more leiomyomas will be detected by abdominal or pelvic imaging by age 50 years in 70% of white women and more than 80% of African American women. Most leiomyomas are asymptomatic, but 25% to 30% of affected women will experience pelvic pain, heavy or prolonged menstrual bleeding, bulk symptoms (ie, pelvic pressure or genitourinary symptoms), and/or reproductive dysfunction. Hysterectomy and myomectomy, the most common surgical treatments for symptomatic leiomyomas, account for approximately 90% to 95% of all procedures nationally; hysterectomy alone accounts for 70% of all leiomyoma surgeries. Little is known about the comparative effectiveness of hysterectomy and myomectomy on health-related quality of life (HRQOL) and other patient-centered measures, or for other patient-reported outcomes. The few studies investigating short-term HRQOL after treatment for leiomyomas found significant improvement after both hysterectomy and myomectomy. This prospective effectiveness analysis was designed to compare short-term HRQOL 6 to 12 weeks after use of hysterectomy or myomectomy for the treatment of women with symptomatic leiomyomas. Data were obtained from COMPARE-UF (Comparing Options for Management: Patient-centered Results for Uterine Fibroids), which is a multisite registry of women at clinical centers across the United States. Comparative effectiveness of leiomyoma treatments on HRQOL was examined in a generalizable sample of women traversing racial, ethnic, age, socioeconomic, and geographic strata. Comparative data were obtained in women with documented leiomyomas 6 to 12 weeks after hysterectomy or myomectomy using the disease-specific Uterine Fibroid Symptom Quality of Life and the generic EuroQoL 5-Dimension Health Questionnaire. Hysterectomy and myomectomy patients were likely to differ in demographic and clinical characteristics and baseline preoperative scores because of the observational design of COMPARE-UF. Therefore, multivariate analysis with inverse propensity weighting methods was used to adjust for these potentially confounding differences. Analyses were also stratified by route of surgery. Eligible participants were women 18 to 54 years old enrolled in COMPARE-UF from registry initiation on November 2015 until June 2018. A total of 1295 patients meeting the study criteria were enrolled: 727 with hysterectomy and 568 with myomectomy. A statistically significantly lower mean score was reported for the leiomyoma-specific HRQOL in women scheduled for hysterectomy compared with those planning myomectomy (44.0 +/- 25.4 vs 50.2 +/- 25.3; P<0.01). Compared with women planning myomectomy, those planning hysterectomy had a higher symptom severity score (60.7 +/- 23.6 vs 51.7 +/- 24.6). Patient responses to the EuroQoL 5-Dimension Health Questionnaire on VAS showed that women undergoing hysterectomy had a lower quality of life compared with those planning to undergo myomectomy (69.3 +/- 20.4 vs 73.4 +/- 18.9; P < 0.01). After propensity adjustment, there were no substantial differences in symptom severity scores between the 2 treatment groups at baseline. There was substantial improvement in HRQOL measures in both groups at 6 to 12 weeks; the mean propensity-adjusted symptom severity score was 4 points lower in hysterectomy patients, compared with myomectomy patients (mean difference, -4.6; 95% confidence interval, -7.0 to -2.3). Compared with myomectomy, hysterectomy patients had better scores on the concern and self-consciousness subscales. These 2 subscale findings were similar comparing minimally invasive myomectomy and minimally hysterectomy groups. Symptom severity scores did not differ between groups receiving abdominal myomectomy and abdominal myomectomy, but there were higher subscale scores on activity and energy/mood with myomectomy. In summary, hysterectomy and myomectomy substantially improved HRQOL at short-term follow-up (6-12 weeks), and there were small but statistically significant differences favoring hysterectomy in the Uterine Fibroid Symptom Quality of Life-specific subscales (concern, activity, and self-consciousness) and overall symptom severity. To determine whether similarity in outcomes across treatment groups persists over time, future studies in this ongoing comparative effectiveness study will address long-term HRQOL outcomes, adjusting for participant and pretreatment characteristics.