Published: 30 July 2020
New research findings will help women and doctors make an informed decision about treatment of uterine fibroids.
The NIHR-funded FEMME trial led by a collaborative group of researchers at the University of Oxford, St George’s Hospital London, and the Universities of Birmingham and Glasgow, compared two competing treatments which allow fertility for symptomatic uterine fibroids, to see which option best reduced symptoms and improved the patient’s quality of life.
The results from the trial, which published in the New England Journal of Medicine, showed that myomectomy, a surgical procedure performed to remove uterine fibroids, resulted in a small but significantly higher quality of life compared with uterine artery embolisation (UAE). UAE is a minimally invasive procedure which shrinks the fibroids by placing tiny beads into the blood vessels which supply them.
A fibroid is a non-cancerous growth of the womb, with 1 in 3 women developing them at some point in their life. They most often occur in women aged 30-50 and develop more frequently in women of African-Caribbean family origin. Approximately half of women with uterine fibroids experience significant symptoms that can include heavy menstrual bleeding, abdominal pain and bloating.
Fibroids may also be associated with infertility and problems during pregnancy, including miscarriage and preterm 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.
Two hundred and fifty-four eligible women, wishing to reduce fibroid symptoms were recruited from over 29 UK hospitals to participate in the trial. Researchers compared the two fertility preserving treatments for uterine fibroids on two patient groups. The first patient group comprised of women with an intention to conceive whilst the second group was made up of black women (who have a particularly high incidence of uterine fibroids).
The women were randomised to receive either a myomectomy or UAE procedure. The trial revealed that contrary to popular belief, rates of conception were shown to be broadly similar between the myomectomy and UAE group. Although 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 higher in the UAE group.
Klim McPherson, Visiting Professor of Public Health Epidemiology at Oxford University and study Chief Investigator, said: “These findings are important and reveal new evidence for our understanding of the best treatment for women with fibroids who wish to avoid a hysterectomy.
“It is worth noting that the myomectomy group reported only marginally higher quality of life score than the Uterine Artery Embolisation group, although on average women in both groups saw improvements. Interestingly, the perceived drawback associated with embolisation, that it might affect the working of the ovaries, was not supported by the evidence in this trial.”
Professor Andy Shennan, Professor of Obstetrics, and Clinical Director NIHR Clinical Research Network South London, said, “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.”
The study was funded by the NIHR Health Technology Assessment Programme
More information about the study is available on the NIHR’s Funding & Awards website