INTRODUCTION
tumor, uterine rupture, fibroid, Uterine artery embolization, Uterine fibroids, temporary occlusion of the arteries, fibroids, infarction
TUMOR, UTERINE RUPTURE, FIBROID, HEAVY MENSTRUAL BLEEDING, FIBROIDS, UTERINE FIBROIDS, UTERINE FIBROIDS, FIBROIDS, UTERUS, INFARCTION
Uterine fibroids are the most common tumor in women of reproductive age, with increasing prevalence as women get older. It is estimated that by the time they are in their 50s, around 80% of women will have developed a fibroid.Recently, childbirth trends have shifted, and more women appear to delay starting their families until their third or fourth decade.The symptoms experienced by women with fibroids may vary depending on the position, size, and number of fibroids. Intramural fibroids are the most common form of fibroid but are frequently asymptomatic. Fibroids can become very large and are often associated with heavy menstrual bleeding. Some clinicians believe that the presence of fibroids may have a negative impact on fertilityThere is still uncertainty as to which is the best treatment for a woman with symptomatic fibroids who wishes to preserve her uterus. To address this, existing and new treatments should be fully evaluated from all perspectives, including the relief of symptoms and the impact on the woman's quality of life, and the data should be subject to careful review.Uterine artery embolization (UAE) involves the temporary occlusion of the arteries supplying the uterus using biocompatible particles and is usually performed under local anesthetic. It causes ischemic infarction from which the uterus usually recovers but the fibroids do not. The use of UAE in women who may wish to conceive is controversial within some sections of the medical community.Both myomectomy and UAE appear to improve the quality of life of women with symptomatic uterine fibroids, but data from high‐quality studies are sparse. For the control of symptoms, the choice is currently unclear and indications and clinical preferences for either modality are varied. Perhaps as a result of the uncertainty of the effect of UAE on fertility, previous randomized controlled trials (RCTs) have not generally included women wishing to get pregnant. This meant that the studies undertaken are poorly designed and inconclusive. One small study reported that the women in the myomectomy arm became pregnant sooner postoperatively than the women in the UAE arm, and live birth rates were significantly lower among the UAE group (relative risk (RR) 2.32, 95% confidence interval (CI) 1.19–4.53; UAE has been performed in Africa and Asia, with reports of success even with large fibroids, as are common in Africa.Myomectomy is also undertaken, but the literature reports a reluctance due to fear of uterine rupture in this and future pregnancies.When compared with the open route, the safety and efficacy of laparoscopic myomectomyPapers discussing UAE are often not in the gynecological literature, which is perhaps not surprising as UAE is undertaken by an interventional radiologist, and many gynecologists around the world are protective of their practice and prefer to manage women from diagnosis to recovery.The aim of the present multicenter open RCT was to assess the clinical effectiveness of these two uterine‐saving fibroid treatments.