Impact of uterine fibroids on quality of life: a national cross-sectional survey

doi:10.1016/j.ejogrb.2018.07.032

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 229, October 2018, Pages 32-37

https://doi.org/10.1016/j.ejogrb.2018.07.032 Get rights and content

Abstract

Objective

To study clinical impact of symptomatic uterine fibroids on women’s health-related perceived quality of life regarding several dimensions.

Study Design

A prospective cross-sectional web-based survey was conducted from August 18^th to September 2^nd 2016 among the general French population of women. A total of 1287 French women over the age of 18, among which 302 reported symptomatic uterine fibroids were surveyed. Data concerning demographics, symptoms and health-related quality of life (HRQL) using the UFS-QoL questionnaire, an overall well-being score and overall discomfort score were collected.

Results

Almost two thirds of surveyed women (n = 193; 64%) reported moderate to severe fibroid-related symptoms (symptom severity score between 40 and 100). The global HRQL score showed that 64% of women (n = 193) reported a moderate to very important impact of fibroids on quality of life (HRQL global score between 0 and 50). The worse HRQL scores were reported for concern (57.5 ± 26.7), energy (58.1 ± 23.2) and self-conscious subscales (63.4 ± 24.3). The mean overall well-being score was lower in women with symptomatic uterine fibroids (6.6 ± 1.7) than in women without (7.3 ± 1.5). The mean overall discomfort score rated by women with symptomatic uterine fibroid was 5.7 ± 2.5 with a score between 6 and 10 reported by 56% of them.

Conclusions

We observed that 64% of surveyed women reported a moderate to very important impact of fibroids on their quality of life. This perceived alteration of quality of life together with the severity of symptomatic fibroids have a significant impact on the overall level of discomfort perceived by women and on their personal quality of life.

Introduction

Uterine fibroids (UF) are benign, smooth muscle tumors [1] and currently the most common benign gynecologic tumors, affecting 20–40% of women of reproductive-age [2]. Even though many fibroids remain asymptomatic, 30% can result in heavy uterine bleeding, anemia, abdominal pain or pressure, increased urinary frequency, and infertility or recurrent miscarriage [[3], [4], [5]]. In a French epidemiological survey, almost 10% of women experienced symptomatic UF and reported on average 2.8 different symptoms over the last 3 months [6]. Another survey conducted in the US also highlighted that the more women reported a high number of symptoms, the greater the impact on quality of life (QoL) was important [7]. Another survey concluded that UF are associated with impairment of QoL and productivity at work [8]. When reaching menopause, symptom burden is likely to decrease in most women [9]. Yet, UF remain a leading cause of hysterectomy in France [6]. Some procedures which are less invasive and preserve fertility are increasingly offered to patients and performed.

Despite the evidence that UF significantly impact women’s QoL [8,10,11], to date, little work has been conducted to examine in detail this impact and compare their overall well-being to women without UF. Quality of life is a major issue since it might influence therapeutic management and is a major endpoint for long term follow-up. Also, it is a key outcome of condition severity and most trials assessing novel treatments take it into account as a secondary or even as a primary outcome [[12], [13], [14], [15]].

Thus, the aim of this survey was to provide a deep analysis regarding specific domains of QoL affected by symptomatic UF and compare their level of well-being to women without UF.

Section snippets

Material and methods

A prospective cross-sectional web-based survey was conducted by Ipsos, a largest company in market and public opinion research, from August 18^th to September 2^nd 2016 among the general French population of women.

The overall study sample has been targeted and investigated throughout the Ipsos Access panel composed of 314 077 panellists in France. Regarding the Ipsos online surveys, extensive quality procedures are in place to ensure that the survey inputs allow for high quality survey outputs.

Results

A total of 24 103 panelists accessed the survey with a response rate of 29%.

Finally, 1 287 French women over 18 were recruited (Table 1), 888 without UF, 302 with currently symptomatic UF, 84 who had symptomatic UF, 13 with asymptomatic UF.

Among women with symptomatic UF, 70 (23%) had only bleeding symptoms (ie heavy, painful, prolonged menstruations, or bleeding between periods), 51 (17%) did not experience any bleeding related symptoms but other symptoms (pain or cramps in the abdomen between

Comment

UF are an important source of morbidity for reproductive-age women, impacting their QoL. While this statement is often repeated, the current survey quantifies and details the magnitude of this morbidity. In our national survey of women affected by symptomatic UF, an important impact on QoL was observed, with almost two-thirds of surveyed patients reporting moderate to severe influence of their condition on QoL. Also, the different dimensions investigated were all negatively affected in

Conclusion

French women with symptomatic UF were significantly affected by their condition in terms of QoL. All explored facets were substantially altered, with concern, energy/mood and self-conscious being the most impacted. These findings highlight the necessity to monitor QoL in women with symptomatic UF upon diagnosis for overall clinical management, but they also raise medico-economic issues for public health due to the high prevalence of UF in premenopausal women.

Funding

The survey was supported by a grant from Gedeon Richter. The funder was not involved in the design and data collection.

Conflict of interest

H. Fernandez, K. Ardaens and I. Queval received financial support for this survey. C. Solignac is an employee of Gedeon Richter France.

Acknowledgements

The authors thank IPSOS for carrying out the survey and for statistical analysis of the data.

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The COMPARE-UF registry is a multiinstitutional prospective observational cohort study of women undergoing treatment for uterine fibroids. A subset of 1384 women aged 31 to 45 years who underwent either abdominal myomectomy (n=237), laparoscopic myomectomy (n=272), abdominal hysterectomy (n=177), laparoscopic hysterectomy (n=522), or uterine artery embolization (n=176) were included in this analysis. We obtained demographics, fibroid history, and symptoms by questionnaires at enrollment and at 1, 2, and 3 years posttreatment. We used the UFS-QoL (Uterine Fibroid Symptom and Quality of Life) questionnaire to ascertain symptom severity and health-related quality of life scores among participants. To account for potential baseline differences across treatment groups, a propensity score model was used to derive overlap weights and compare total health-related quality of life and symptom severity scores after enrollment with a repeated measures model. For this health-related quality of life tool, a specific minimal clinically important difference has not been determined, but on the basis of previous research, a difference of 10 points was considered as a reasonable estimate. Use of this difference was agreed upon by the Steering Committee at the time when the analysis was planned.
At baseline, women undergoing hysterectomy and uterine artery embolization reported the lowest health-related quality of life scores and highest symptom severity scores compared with those undergoing abdominal myomectomy or laparoscopic myomectomy (P<.001). Those undergoing hysterectomy and uterine artery embolization reported the longest duration of fibroid symptoms with a mean of 6.3 years (standard deviation, 6.7; P<.001). The most common fibroid symptoms were menorrhagia (75.3%), bulk symptoms (74.2%), and bloating (73.2%). More than half (54.9%) of participants reported anemia, and 9.4% women reported a history of blood transfusion. Across all modalities, total health-related quality of life and symptom severity score markedly improved from baseline to 1-year with the largest improvement in the laparoscopic hysterectomy group (Uterine Fibroids Symptom and Quality of Life: delta= [+] 49.2; symptom severity: delta= [−] 51.3). Those undergoing abdominal myomectomy, laparoscopic myomectomy, and uterine artery embolization also demonstrated significant improvement in health-related quality of life (delta= [+]43.9, [+]32.9, [+]40.7, respectively) and symptom severity (delta= [−]41.4, [−] 31.5, [−] 38.5, respectively) at 1 year, and the improvement persisted from baseline for uterine-sparing procedures during second (Uterine Fibroids Symptom and Quality of Life: delta= [+]40.7, [+]37.4, [+]39.3 SS: delta= [−] 38.5, [−] 32.0, [−] 37.7 and third year (Uterine Fibroids Symptom and Quality of Life: delta= [+] 40.9, [+]39.9, [+]41.1 and SS: delta= [−] 33.9, [−]36.5, [−] 33.0, respectively), posttreatment intervals, however with a trend toward decline in degree of improvement from years 1 and 2. Differences from baseline were greatest for hysterectomy; however, this may reflect the relative importance of bleeding in the Uterine Fibroids Symptom and Quality of Life, rather than clinically meaningful symptom recurrence among women undergoing uterus-sparing treatments.
All treatment modalities were associated with significant improvements in health-related quality of life and symptom severity reduction 1-year posttreatment. However, abdominal myomectomy, laparoscopic myomectomy and uterine artery embolization indicated a gradual decline in symptom improvement and health-related quality of life by third year after the procedure.
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To evaluate the efficacy of UPA in women with fibroid induced menorrhagia.
Embase, MEDLINE, CAB Abstracts, Cochrane Central Register of Controlled Trials, PsychInfo were searched up to 18th May 2020 and updated on 7th February 2021. Randomised controlled trials evaluating the efficacy of UPA in women with fibroid induced menorrhagia were included in the study.
Two authors independently reviewed and extracted the study data. Statistical heterogeneity was quantified using I² statistics. Publication bias and data asymmetry was assessed by funnel plots. A meta-analysis was conducted where appropriate. Six studies were eligible for inclusion. UPA (5 mg and 10 mg) achieved statistically significant amenorrhoeic outcome when compared to placebo (p<0.00001). Increased adverse events (AE) profile was observed in the higher UPA dose, however, did not reach statistical significance.
This review demonstrates the efficacy of UPA in achieving amenorrhoea in women with fibroid induced menorrhagia. However, the favourable dose of UPA remains inconclusive when AE profile is taken into account. Evidence remains obscure regarding liver damage and further research is warranted to attain a conclusive outcome.
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Full length articleImpact of uterine fibroids on quality of life: a national cross-sectional survey

Abstract

Objective

Study Design

Results

Conclusions

Introduction

Section snippets

Material and methods

Results

Comment

Conclusion

Funding

Conflict of interest

Acknowledgements

Fertil Steril

J Gynecol Obstet Biol Reprod (Paris)

Eur J Obstet Gynecol Reprod Biol

Obstet Gynecol

Eur J Obstet Gynecol Reprod Biol

Community Health Stud

Uterine fibroids: the elephant in the room

Science

Uterine myomas: an overview of development, clinical features, and management

Obstet Gynecol

Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women

BMC Womens Health

Full length article
Impact of uterine fibroids on quality of life: a national cross-sectional survey