Women’s health before and after myomectomy

Introduction. Recently, special attention has been paid to the quality of life of women and its changes after myomectomy.

Aim. To assess the effect of myomectomy on menstrual function and quality of life in women with uterine fibroids.

Materials and methods. A prospective clinical observational study was carried out at the clinical sites of the Department of Obstetrics and Gynecology with a course of perinatology at the Medical Institute of the RUDN University named after. Patrice Lumumba. Women of reproductive age with uterine fibroids (n = 80) and indications for organ-preserving treatment were selected, their complaints, general and obstetric-gynecological anamnesis, clinical, laboratory and instrumental studies of the patients were analyzed. The UFS-QOL questionnaire developed by the SIR Foundation was used to assess the severity of uterine fibroid symptoms and quality of life. Accumulation, adjustment, systematization of source information and statistical analysis were carried out using the IBM SPSS Statistics v. 23 program (IBM Corporation).

Results. The average age of women with uterine fibroids was 40.36 ± 4.5 (27–49) years. During surgery, one myomatous node was removed in 61 (76.3%) women; in the rest, from 2 to 7 myomas were removed. Localization of removed fibroids according to the classification of The International Federation of Gynecology and Obstetrics 2018 (FIGO): in 3 (3.75%) women it was classified as type 7 according to FIGO – in 1 patient the node was isthmus, in 2 it was intraligamentous. The size of the identified fibroids varied from 0.5 cm to 15 cm (3.78 ± 3.0). 50% of patients with uterine fibroids had heavy menstruation, and 27.5% were  diagnosed with iron deficiency anemia. When assessing the average severity of symptoms of uterine fibroids before and after myomectomy, it was found to decrease from 31.46 ± 20.0 (0–93.75) to 14.91 ± 17.1 (0–84.37) (p < 0.001). The HRQL total quality of life score also increased from 71.14 ± 20.7 (22.41–100) to 82.05 ± 17.6 (30.17–100) (p < 0.001). The number of women after myomectomy with a total HRQL level of more than 75 increased statistically significantly by 27.5% and decreased by 20% in the range of 50–75 (p < 0.05). However, when analyzing the results of the UFS-QOL questionnaires, it was found that in 7 (8.75%) patients the quality of life did not change before and after myomectomy, and in 12 (15%) women, despite a decrease in the severity of symptoms of uterine fibroids after myomectomy, quality of life (HRQL total) became slightly lower (Wilcoxon test 129.5, p = 0.242). 6 (7.5%) women experienced worsening symptoms of uterine fibroids after surgery: 25.52 ± 11.4 (9.38–43.75) before myomectomy and 33.33 ± 13.6 (12.5–50) after (Wilcoxon test 30, p = 0.146).

Conclusions. Myomectomy did not always lead to healthier women and an improvement in their quality of life. Further research in this area is required.

1. Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM. The UFS-QOL, a new disease-specific symptom and healthrelated quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002;99(2):290–300. https://doi.org/10.1016/s0029-7844(01)01702-1.

2. Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124(10):1501–1512. https://doi.org/10.1111/1471-0528.14640.

3. De La Cruz MSD, Buchanan EM. Uterine Fibroids: Diagnosis and Treatment. Am Fam Physician. 2017;95(2):100–107. Available at: https://www.aafp.org/pubs/afp/issues/2017/0115/p100.html.

4. McKain L, Edsall K, Dufour R, Lickert C. Treatment Patterns in Patients with Uterine Fibroids With and Without a Diagnosis of Heavy Menstrual Bleeding: Results from a Large U.S. Claims Database. J Womens Health. 2023;32(3):332–340. https://doi.org/10.1089/jwh.2022.0056.

5. Sohn GS, Cho S, Kim YM, Cho CH, Kim MR, Lee SR. Current medical treatment of uterine fibroids. Obstet Gynecol Sci. 2018;61(2):192–201. https://doi.org/10.5468/ogs.2018.61.2.192.

6. Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020;149(1):3–9. https://doi.org/10.1002/ijgo.13102.

7. Rezk A, Kahn J, Singh M. Fertility Sparing Management in Uterine Fibroids. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK574504.

8. Cappelli A, Mosconi C, Cocozza MA, Brandi N, Bartalena L, Modestino F et al. Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids of Different Sizes: A Single Center Experience. J Pers Med. 2023;13(6):906. https://doi.org/10.3390/jpm13060906.

9. Sirkeci F, Moss J, Belli AM, McPherson K, Daniels J, Manyonda I et al. Effects on heavy menstrual bleeding and pregnancy of uterine artery embolization (UAE) or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: The FEMME randomized controlled trial. Int J Gynaecol Obstet. 2023;160(2):492–501. https://doi.org/10.1002/ijgo.14626.

10. Aktürk H, Dura MC, Gürsoy B, Ikizoğlu F, Göl E, Alsalamin WOI, Ekin M. Comparison of Recurrence and Quality of Life Between Myoma Embolization and Myomectomy. Cureus. 2023;15(6):e40372. https://doi.org/10.7759/cureus.40372.

11. Stuklov NI, Levakov SA, Sushinskaya TV, Mitchenkova AA, Kovalchuk MO. Prevention and treatment of anemia in reproductive-aged women with gynecological diseases. Akusherstvo i Ginekologiya (Russian Federation). 2020;(3):218–226. (In Russ.) https://doi.org/10.18565/aig.2020.3.218-226.

12. Radzinsky VE, Orazov MR, Kostin IN. Chronic pelvic pain in gynecological practice. Doctor.Ru. 2019;(7):30–35. (In Russ.) https://doi.org/10.31550/1727-2378-2019-162-7-30-35.

13. Penner VA, Borisenko VV, Udovika NA, Kharchenko OS. Pain Syndromes in Patients with Uterine Myoma. Russian Journal of Pain. 2018;(2):184–186. (In Russ.) Available at: https://www.elibrary.ru/xodufv.

14. Stewart EA, Lukes AS, Venturella R, Li Y, Hunsche E, Wagman RB, Al-Hendy A. Quality of life with relugolix combination therapy for uterine fibroids: LIBERTY randomized trials. Am J Obstet Gynecol. 2023;228(3): 320.e1–320.e11. https://doi.org/10.1016/j.ajog.2022.11.1278.

15. Yang Q, Ciebiera M, Bariani MV, Ali M, Elkafas H, Boyer TG, Al-Hendy A. Comprehensive Review of Uterine Fibroids: Developmental Origin, Pathogenesis, and Treatment. Endocr Rev. 2022;43(4):678–719. https://doi.org/10.1210/endrev/bnab039.

16. Li B, Wang F, Chen L, Tong H. Global epidemiological characteristics of uterine fibroids. Arch Med Sci. 2023;19(6):1802–1810. https://doi.org/10.5114/aoms/171786.

17. Kartseva MA. Employment and health of the “sandwich generation” in Russia: empirical analysis. Monitoring Obshchestvennogo Mneniya: Ekonomicheskie i Sotsial’nye Peremeny. 2021;(5):324–344. https://doi.org/10.14515/monitoring.2021.5.1844.

18. Di Spiezio Sardo A, Ciccarone F, Muzii L, Scambia G, Vignali M. Use of oral GnRH antagonists combined therapy in the management of symptomatic uterine fibroids. Facts Views Vis ObGyn. 2023;15(1):29–33. https://doi.org/10.52054/FVVO.15.1.059.

19. Uimari O, Subramaniam KS, Vollenhoven B, Tapmeier TT. Uterine Fibroids (Leiomyomata) and Heavy Menstrual Bleeding. Front Reprod Health. 2022;4:818243. https://doi.org/10.3389/frph.2022.818243.

20. Wang A, Wang S, Owens CD, Vora JB, Diamond MP. Health Care Costs and Treatment Patterns Associated with Uterine Fibroids and Heavy Menstrual Bleeding: A Claims Analysis. J Womens Health. 2002;31(6):856–863. https://doi.org/10.1089/jwh.2020.8983.

21. Petraglia F, Dolmans MM. Iron deficiency anemia: Impact on women’s reproductive health. Fertil Steril. 2022;118(4):605–606. https://doi.org/10.1016/j.fertnstert.2022.08.850.

22. Wallace K, Stewart EA, Wise LA, Nicholson WK, Parry JP, Zhang S et al. Anxiety, Depression, and Quality of Life After Procedural Intervention for Uterine Fibroids. J Womens Health. 2022;31(3):415–424. https://doi.org/10.1089/jwh.2020.8915.

23. Keizer AL, Jacobs BL, Thurkow AL, de Lange ME, Radder CM, van Kesteren PJM et al. The effect of transcervical resection of submucous fibroids on menstrual blood loss: A prospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2022;274:128–135. https://doi.org/10.1016/j.ejogrb.2022.05.019.

24. Baratov AK, Rakhimov FR, Kalmykov EL. Assessment of the UFS-QOL questionnaire before and after uterine artery embolization for uterine leiomyoma. Avicenna Bulletin. 2020;22(3):362–372. (In Russ.) https://doi.org/10.25005/2074-0581-2020-22-3-362-372.