Clinical trial helps resolve dilemma for women who have fibroids
Published: 30 July 2020
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The results of a large clinical trial will help women and doctors make a more informed decision about the treatment of uterine fibroids.
Researchers at St George’s and the Universities of Oxford, Birmingham, Glasgow and Nottingham, funded by the National Institute for Health Research compared two fertility preserving treatments for the non-cancerous growths that develop in or around the womb, known as uterine fibroids.
The results from the trial, which published in the NEJM today, showed that myomectomy, a surgical procedure performed to remove the fibroids, resulted in a small but significantly higher quality of life compared with uterine artery embolisation. Embolisation is a less invasive procedure which shrinks the fibroids by placing tiny beads into the blood vessels which supply them. Over 250 women, treated by doctors at 29 hospitals, took part in the trial.
A fibroid is a non-cancerous growth of the womb, with one in three women developing them at some point in their life. They most often occur in women aged 30-50 and develop more frequently in black women. Approximately half of women with uterine fibroids experience significant symptoms that can include heavy menstrual bleeding, abdominal pain and bloating.
Fibroids may be associated with infertility and problems during pregnancy, including miscarriage and premature birth. As more women are having children at a later age, fibroids are becoming more of an issue for them and safe and effective fertility sparing treatments are needed. The trial revealed that, contrary to popular belief, the embolisation procedure did not have a negative impact on hormones associated with fertility. Too few trial participants were trying to get pregnant to be able to determine with certainty whether there was an impact of either treatment on pregnancy rates, which was nonetheless higher in the embolisation group.
Professor Isaac Manyonda, lead author on the paper, from St George’s, University of London and St George’s Hospital, said: “With many women delaying childbirth until their late thirties and early forties, when fibroids are more likely to be an issue, research on uterus-preserving interventions has never been more important.
“Our results show that women now have a wider choice of options for treatment of symptomatic fibroids, both of which significantly improve quality of life. The next stages for research will be to further understand how these treatments may affect pregnancy to improve outcomes for anyone looking to have children.”
Professor Andy Shennan, Professor of Obstetrics, and Clinical Director NIHR Clinical Research Network South London, stated: “This work is a major contribution to knowledge on the management of the most common tumour in women of reproductive age. The researchers found a significant but small advantage for myomectomy in terms of quality of life, while observing slightly more pregnancies in the UAE arm, which provides wider treatment choices for women with symptomatic fibroids."