A UK Multicenter Retrospective Cohort Study Comparing Hysterectomy and Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids (HOPEFUL Study): Main Results on Medium-term Safety and Efficacy

The Hysterectomy Or Percutaneous Embolization For Uterine Leiomyomata (HOPEFUL) study was an attempt to compare the effectiveness, safety, and cost-effectiveness of 2 methods of treating symptomatic uterine fibroids, hysterectomy, and uterine artery embolization (UAE). The multicenter retrospective cohort study enrolled 459 women having hysterectomy and followed-up for 8.6 years on average, and 649 others who underwent UAE and were followed for 4.6 years on average. A majority of hysterectomies were total abdominal procedures. Complications were more frequent in women having hysterectomy. The adjusted odds ratio for UAE versus hysterectomy was 0.48, with a 95% confidence interval of 0.26–0.89. One-third of women having UAE experienced general side effects expected with this procedure, including vaginal discharge, spontaneous fibroid expulsions, and postembolization syndrome. More women in the hysterectomy group reported relief from fibroid symptoms (95% vs. 85%), and more of them felt better than before treatment (96% vs. 84%). Nevertheless, only 85% of women would recommend hysterectomy to a friend, whereas 91% would recommend UAE. Nearly one-fourth of women having UAE required further treatment for fibroids. Twenty-seven women had 37 pregnancies following UAE, resulting in 19 live births. Nearly 80% of live births were delivered by cesarean section. UAE produces fewer complications than hysterectomy in women with symptomatic uterine fibroids. Side effects do occur, however, and a significant proportion of women require further treatment for fibroid symptoms. Both hysterectomy and UAE seem to be safe and effective over the medium term.