Original Title: Application 1081

Authors' results and conclusions: Safety - Overall, uterine artery embolisation (UAE) appears to be as safe as, or safer than, abdominal hysterectomy with fewer major complications. Further research comparing the relative safety of UAE with the less invasive treatment of laparoscopic hysterectomy would provide some interesting comparisons. Based on the limited data, it appears that UAE is probably as safe as, or safer than, abdominal myomectomy. The higher rate of early menopause after UAE compared to myomectomy is the most concerning safety outcome. The reason for the higher rate of menopause could be because the collateral arteries of the ovaries are compromised during embolisation of the uterine artery feeding the fibroid, whereas during myomectomy the fibroid is surgically removed in an open technique with better visualisation. Further comparative research needs to be conducted on the safety of UAE compared to other uterine-conserving fibroid treatments. Effectiveness - Based on the highest levels of evidence, UAE appears to be less effective at resolving the primary symptoms (menorrhagia, pain and bulk/pressure) associated with uterine fibroids, and is associated with equivalent improvements in quality of life, when compared to abdominal hysterectomy. UAE patients are more likely to need further treatment, but this minimally invasive procedure is associated with a significantly reduced convalescence time, when compared to hysterectomy. UAE is unlikely to affect ovarian function. Overall, the minimally invasive, uterine-conserving treatment of UAE appears to be less effective than hysterectomy. The highest available evidence reported that UAE patients were more likely to report completely or significantly resolved menorrhagic and pain symptoms compared to abdominal myomectomy. There was reported a shorter return time to normal activities and less days taking pain medication for UAE patients compared to abdominal myomectomy patients. The effect of UAE on pregnancy outcome is debatable, and is likely to remain that way because further childbearing is a relative contraindication for UAE. Overall, based on limited data, UAE appears to be as, or more, effective than abdominal myomectomy. Important areas that are currently under-researched include determination of fibroid or symptom recurrence and the rate of follow-up treatments for UAE compared to other uterine-conserving fibroid treatments.

Project Status: Completed

URL for project: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1081-public

Year Published: 2006

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/625913837CFD544ECA25801000123B6E/$File/1081-Assessment-Report.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: <p>Adelaide Health Technology Assessment (AHTA) on behalf of NICS</p>