Uterine Artery Embolization Versus Hysterectomy in the Treatment of Symptomatic Uterine Fibroids: 2 Years’ Outcome From the Randomized EMMY Trial

Available reports suggest that uterine artery embolization (UAE) has advantages over surgery when treating heavy menstrual bleeding caused by uterine fibroids, but some of these studies lack a control group of women treated in other ways—as by hysterectomy. The EMMY trial (comparing EMbolization with hysterectoMY), conducted at 28 Dutch hospitals, compared the efficacy of UAE with that of hysterectomy for treating menorrhagia resulting from uterine fibroids. Women describing increased or prolonged menstrual blood loss that interfered with daily life were included in the trial. A total of 88 patients were randomized to UAE and 89 to hysterectomy, which usually was performed transabdominally. The primary end point was whether, after a prospective 24-month follow-up interval, UAE avoided subsequent hysterectomy in at least 75% of cases. UAE failed bilaterally in 4 patients who later underwent hysterectomy. The rate of unilateral failure was 12%. In all, 23.5% of patients assigned to UAE had undergone hysterectomy 2 years after treatment. The hysterectomies were evenly distributed over time. All but one of them were done for persistent or recurrent menorrhagia. There were no significant group differences in the rate of improvement in either lower abdominal pain or bulk-related symptoms. Pain was less than at baseline in more than three-fourths of both patient groups, and bulk-related symptoms in at least two-thirds of women in each group. Reductions in uterine volume and fibroid volume following UAE were highly significant. Blood hemoglobin levels rose significantly in both groups compared to baseline values. The investigators conclude that UAE is a sound alternative to hysterectomy in women with symptomatic uterine fibroids. Nevertheless, hysterectomy remains the preferred treatment for patients who wish to be certain that bleeding will cease.