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In a prospective cohort study, women with uterine fibroids reported significant symptom relief and improved quality of life for two years after either laparoscopic radiofrequency ablation or myomectomy. Myomectomy had a modest early advantage, but the differences between procedures remained below thresholds considered clinically meaningful.
A prospective study of 401 women with uterine fibroids found that laparoscopic radiofrequency ablation and myomectomy were each followed by sustained symptom relief and improved health-related quality of life over two years. Myomectomy showed a small statistical advantage in average scores, but the difference did not reach the study’s thresholds for a clinically meaningful change, the researchers reported.
The multicenter ULTRA study enrolled premenopausal women with symptomatic fibroids who planned a uterine-preserving procedure. Of the 401 participants, 237 underwent laparoscopic radiofrequency ablation and 164 underwent myomectomy; 386 completed at least one follow-up assessment and were included in the analysis. Their mean age was 39, and the cohort included women treated at academic and community medical centers across the United States.
In propensity-weighted analyses over 24 months, symptom severity scores fell by 33.0 points after myomectomy and 27.7 after radiofrequency ablation, a between-group difference of 5.27 points. Quality-of-life scores rose by 34.92 and 28.29 points, respectively, a difference of 6.62 points. The study’s thresholds for minimally clinically important change were 10 points for symptom severity and 20 points for quality of life, so the measured differences between treatments were below those levels.
At six months, myomectomy was associated with modestly greater gains on several questionnaire measures. By 24 months, those between-group differences had disappeared, according to the researchers. Participants were followed for three to five years overall, but this report analyzed outcomes only through the first two years after surgery.
Choosing Between Uterine-Preserving Procedures
The findings give patients and clinicians comparative information about two options that preserve the uterus, while showing that average symptom and quality-of-life scores alone did not establish a clinically meaningful advantage for either procedure over two years. Treatment decisions may also depend on fibroid characteristics, personal goals, and reproductive plans, the researchers said.
Radiofrequency ablation treats the center of a fibroid, which then shrinks over time. The report says it may suit some women who want symptom management while retaining the option of vaginal childbirth. Myomectomy removes fibroids, and study author Antoinette Allen told MedPage Today that nearly all women who undergo myomectomy end up having a cesarean delivery. Individual outcomes and delivery plans can vary, so the study does not establish which procedure is preferable for every patient.
Why the Comparison Was Studied
Uterine fibroids, also called leiomyomas, are benign growths that affect an estimated 70% to 80% of women by age 50, according to the report. The researchers noted that fibroids are more common and tend to appear earlier and grow larger in Black women. The ULTRA cohort reflected a range of backgrounds: 53.0% of participants were Black, 20.2% white, 13.4% Hispanic, and 7.1% Asian.
Hysterectomy is a definitive treatment, but it removes the uterus and is not suitable for people seeking future fertility or uterine preservation. The study authors also cited concerns about possible long-term health risks associated with hysterectomy, including among some younger women. They said prior comparisons of radiofrequency ablation and myomectomy were limited by small cohorts and shorter follow-up, prompting this prospective study of patient-reported outcomes.
“Longitudinally, they both work really, really well, but I do think that myomectomy does have its initial advantage.”
— Antoinette Allen, MD, of Weill Cornell Medicine, speaking to MedPage Today
Limits of the Two-Year Findings
The study was observational rather than randomized, and patients receiving the two procedures differed in baseline fibroid characteristics. The authors also noted that myomectomy patients tended to enter the study later than those receiving radiofrequency ablation. These factors may have affected the comparisons, and residual confounding cannot be ruled out.
The analysis does not establish whether the outcomes remain similar beyond 24 months, even though some participants were followed for three to five years. It also does not show that every patient will experience the same degree of relief or resolve which procedure is best for a particular fibroid pattern, fertility goal, or delivery plan.
Longer Follow-Up May Add Clarity
The ULTRA study followed participants for up to three to five years, but this analysis covered only the first two years. Further reporting on later follow-up could show whether symptom relief and quality-of-life changes persist and whether differences between procedures emerge over time. For now, the researchers’ findings support discussion of both options in light of a patient’s clinical characteristics and goals.
Key Questions
Did both procedures improve fibroid symptoms?
Yes. The study reported significant and sustained improvement in symptoms and health-related quality of life after both laparoscopic radiofrequency ablation and myomectomy through two years.
Was one procedure clearly better?
Myomectomy had a modest advantage in average scores, including at six months. By 24 months the differences had disappeared, and the measured between-group differences were below the study’s thresholds for clinically meaningful change.
How do the procedures differ?
Radiofrequency ablation treats the center of a fibroid so it can shrink over time. Myomectomy removes the fibroid. The study compared outcomes but did not determine which approach is best for every patient.
Does this study answer which option is better for future childbirth?
No. The report says radiofrequency ablation may be preferred by some women seeking to preserve the option of vaginal childbirth, while the study author said nearly all women after myomectomy have a cesarean delivery. The analysis did not compare childbirth outcomes as its main measure.
What are the study’s main limitations?
It was not randomized, the treatment groups differed in some baseline characteristics, and the analysis covered only the first two years. Those limits mean the results cannot establish that the procedures have identical effects for all patients or over longer periods.
Source: rss
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