CLINICAL INVESTIGATION ARTERIAL INTERVENTIONS Uterine Artery Embolization versus Myomectomy: Impact on Quality of Life—Results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial Isaac T. Manyonda • Mark Bratby • Jessica S. Horst • Nassera Banu • Maha Gorti • Anna-Maria Belli Received: 1 March 2011 / Accepted: 10 June 2011 / Published online: 20 July 2011 Ó Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2011 Abstract Purpose This study was designed to compare quality of life (QoL) outcomes after uterine artery embolization (UAE) or myomectomy. Methods Women with symptomatic fibroids diagnosed by ultrasound who wished to preserve their uterus were randomized to myomectomy (n = 81) or UAE (n = 82). Endpoints at 1 year were QoL measured by a validated questionnaire, hospital stay, rates of complications, and need for reintervention. Results UAE patients had shorter hospitalization (2 vs. 6 days, p \ 0.001). By 1 year postintervention, significant and equal improvements in QoL scores had occurred in both groups (myomectomy n = 59; UAE n = 61). There had been two (2.9%) major complications among UAE versus 6 (8%) among myomectomy patients (not signifi- cant). By 2 years, among UAE patients (n = 57) there were eight (14.0%) reinterventions for inadequate symp- tom control compared with one (2.7%) among myomec- tomy patients (n = 37). Half of the women who required hysterectomy had concomitant adenomyosis missed by US. Conclusions UAE and myomectomy both result in sig- nificant and equal improvements in QoL. UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention. Keywords Fibroid Á Myomectomy Á Quality of life Á Uterine artery embolization Introduction A woman with symptomatic fibroids seeking treatment and wishing to preserve her uterus currently has the options of myomectomy [1] or the radiological therapies, uterine artery embolization (UAE) or high-intensity focussed ultrasound (HIFU) [2]. The number of such women is increasing because fibroids are most symptomatic in the 30–40-year age group, and women are starting their fam- ilies in their 30 s or later [3]. Hysterectomy is regarded as too radical by many patients, regardless of fertility con- cerns. Therefore, myomectomy often is offered if fertility retention is explicitly sought, but UAE is less invasive, cheaper, and associated with a shorter hospital stay and a quicker recovery [2]. UAE could be an attractive alterna- tive to myomectomy if robust data on quality of life and some comparable information on subsequent fertility were available. However, there are very little data that allow an evidence-based choice between the two. Myomectomy is the time-honored conventional treatment of proven efficacy with regard to symptom relief [4] and improved fertility outcome [5], but it is associated with significant morbidity, especially excessive operative blood loss, adhesion for- mation, and recurrence of fibroids, all of which might compromise the fertility potential for which it often is performed [6–8]. UAE is now widely used, and its safety, This study was approved by the Wandsworth Research Ethics committee (Ref 01.96.3). I. T. Manyonda (&) Á N. Banu Á M. Gorti Department of Gynaecology, St. George’s Hospital, Blackshaw Road, London SW17 0QT, UK e-mail: imanyond@sgul.ac.uk M. Bratby Á A.-M. Belli Department of Radiology, St. George’s Hospital, Blackshaw Road, London SW17 0QT, UK J. S. Horst University of Sussex, School of Psychology, Pevensey 1, Room 1C9, Falmer, Brighton BN1 9QH, UK 123 Cardiovasc Intervent Radiol (2012) 35:530–536 DOI 10.1007/s00270-011-0228-5