Abstract
Objective
To examine the use of medical management, uterus-preserving surgery (UPS), and complementary
treatments among women with uterine fibroids.
Study design
Prospective cohort study of 933 premenopausal women ages 31–54 years with symptomatic
fibroids who participated in the Study of Pelvic Problems, Hysterectomy, and Intervention
Alternatives (SOPHIA) for an average of 4.3 years (SD 2.5 years). Incident use of
fibroid treatments was determined through annual interviews. Linear regression models
were used to compare changes in fibroid-related symptoms among women who underwent
UPS versus those who did not undergo surgery.
Results
Participants were racially and ethnically diverse, with a mean age of 43 years. During
study follow-up, 531 participants (57%) did not undergo UPS or hysterectomy, 250 (27%)
had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative
treatments were commonly used, including exercise (45%), diet (34%), herbs (37%),
and acupuncture (16%): participants reported significant symptom improvement and few
side effects with these interventions. In multivariable linear regression models,
women who did not undergo surgery during the study reported improvement in dyspareunia
(p < .001), pelvic pain (p < .001), and menstrual cramps (p < .001). However, women who underwent UPS reported greater overall resolution of “pelvic
problems” compared with women who did not have surgical treatment (difference in change
score 1.18 on a four-point Likert scale, p < .001).
Conclusion
UPS are effective treatments for women with fibroids, but many women use hormonal
or complementary treatments and report significant symptom improvement without surgical
intervention.
Keywords
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Article info
Publication history
Published online: September 14, 2014
Accepted:
September 3,
2014
Received in revised form:
August 28,
2014
Received:
May 8,
2014
Identification
Copyright
© 2014 Published by Elsevier Inc.