Patient Report of Subsequent Uterine-Sparing Leiomyomata Procedures up to 10 Years

OBJECTIVE: To determine risk of subsequent treatment after uterine-sparing procedures for uterine leiomyomata. METHODS: Study participants from two uterine leiomyomata procedure studies were recontacted. The baseline procedures studied included myomectomy, endometrial ablation, laparoscopic ultrasound–guided radiofrequency ablation (RFA), and uterine artery embolization (UAE). Participants reported all uterine leiomyomata procedures after their baseline uterine-sparing leiomyomata procedure. The subsequent treatment options analyzed included the baseline uterine leiomyomata procedures plus hysterectomy and magnetic resonance imaging (MRI)–guided focused ultrasonography. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate differences in retreatment risk according to baseline procedure by means of hazard ratios (HRs) and corresponding 95% CIs. Fisher exact tests were used to examine the association between baseline procedure and retreatment procedure. RESULTS: The total number of participants in the study is 817. Median age at baseline procedure was 39.7 years; participant median age at recontact was 46.8 years. Follow-up after baseline procedure was 4.0–10.5 years. Baseline procedure types included myomectomy (n=469, 66.0%), endometrial ablation (n=90, 12.7%), RFA (n=96, 13.5%), and UAE (n=56, 7.9%). Of the 204 participants (28.7%) who had retreatment for uterine leiomyomata, the most common subsequent procedure was hysterectomy (n=94, 46.1%), followed by myomectomy (n=57, 27.9%), UAE (n=26, 12.7%), endometrial ablation (n=12, 5.9%), MRI-guided focused ultrasonography (n=9, 4.4%), and RFA (n=6, 2.9%). Within 5 years after the baseline procedure, 79.1% (95% CI, 76.2–82.1%) had no additional uterine procedures; 64.1% (95% CI, 57.7–71.2%) had none within 10 years. When endometrial ablation, RFA, and UAE were compared with myomectomy, RFA was found to have a higher retreatment rate (HR 1.61, 95% CI, 1.08–2.40). Those who had undergone myomectomy at baseline were the least likely (10.9%) and those who had undergone endometrial ablation were most likely (22.2%) to have a subsequent hysterectomy. CONCLUSION: The majority of women who have uterine-sparing uterine leiomyomata procedures can remain treatment free for 5–10 years. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT06430320.