Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids

Fertil Steril. 2020 Mar;113(3):618-626. doi: 10.1016/j.fertnstert.2019.10.028.


Objective: To compare long-term health-related quality of life (HRQOL) 1 year after hysterectomy or myomectomy for treatment of uterine fibroids (UFs) and to determine whether route of procedure, race, or age affected improvements in HRQOL.

Design: Prospective cohort study.

Setting: Eight clinical sites throughout the United States.

Patient(s): A total of 1,113 premenopausal women with UFs who underwent hysterectomy or myomectomy as part of Comparing Options for Management: Patient-Centered Results for Uterine Fibroids.

Intervention(s): None.

Main outcome measure (s): Self-reported HRQOL measures including Uterine Fibroid Symptom Quality of Life, the European QOL 5 Dimension Health Questionnaire, and the visual analog scale at baseline and 1-year after hysterectomy or myomectomy.

Result (s): Hysterectomy patients were older with a longer history of symptomatic UF compared with myomectomy patients. There were no differences in baseline HRQOL. After adjustment for baseline differences between groups, compared with myomectomy, patients' HRQOL (95% confidence interval [CI], 5.4, 17.2) and symptom severity (95% CI, -16.3, -8.8) were significantly improved with hysterectomy. When stratified across race/ethnicity and age, hysterectomy had higher HRQOL scores compared with myomectomy. There was little difference in HRQOL (95% CI, 0.1 [-9.5, 9.6]) or symptom severity (95% CI, -3.4 [-10, 3.2]) between abdominal hysterectomy and abdominal myomectomy.

Conclusion (s): HRQOL improved in all women 1 year after hysterectomy or myomectomy. Hysterectomy patients reported higher HRQOL summary scores compared with myomectomy patients. When stratified by route, minimally invasive hysterectomy had better HRQOL scores than minimally invasive myomectomy. There was little difference in scores with abdominal approaches.

Keywords: Hysterectomy; minimally invasive; myomectomy; quality of life; uterine fibroids.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Cohort Studies
  • Comparative Effectiveness Research
  • Female
  • Follow-Up Studies
  • Humans
  • Hysterectomy* / adverse effects
  • Hysterectomy* / rehabilitation
  • Hysterectomy* / statistics & numerical data
  • Leiomyoma / epidemiology
  • Leiomyoma / psychology
  • Leiomyoma / surgery*
  • Middle Aged
  • Pregnancy
  • Prospective Studies
  • Quality of Life*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Uterine Artery Embolization / adverse effects
  • Uterine Artery Embolization / rehabilitation
  • Uterine Artery Embolization / statistics & numerical data
  • Uterine Myomectomy* / adverse effects
  • Uterine Myomectomy* / rehabilitation
  • Uterine Myomectomy* / statistics & numerical data
  • Uterine Neoplasms / epidemiology
  • Uterine Neoplasms / psychology
  • Uterine Neoplasms / surgery*