Ten-year results of the Emmy Trial (EMbolization versus hysterectoMY) confirm that uterine artery embolization (UAE) is a safe and effective alternative to hysterectomy. Given these findings, researchers concluded that the majority, about two-thirds, of women undergoing UAE for treatment of symptomatic uterine fibroids can avoid having a hysterectomy all together.
For two decades, UAE has been described as a minimally invasive alternative to hysterectomy—a procedure that surgically removes the uterus. In contrast, UAE involves only a tiny nick in the groin or wrist to access the arteries that lead to the uterine arteries. A doctor called an interventional radiologist then inserts a thin catheter and releases small particles called embolics to block blood flow to the fibroids, causing them to shrink and symptoms to subside.
In 2005, the EMMY Trial sought to evaluate UAE in comparison to hysterectomy for the treatment of fibroids.1 Between 2002 and 2004, 177 women who suffered from symptomatic fibroids and who were eligible for hysterectomy were recruited from 28 Dutch hospitals.
Overall, 81 women were randomly assigned to UAE and 75 to hysterectomy. The remaining twenty-one patients withdrew from the trial. Results showed that UAE had comparably low major complication rates that were similar to hysterectomy. Although linked with more minor complications, such as bruising at the puncture site or nausea, UAE had a significantly shorter hospital stay. Quality of life improved dramatically in both groups.
10-years later, Dr. Annefleur M. de Bruijn, MD, and a team of researchers at the VU University Medical Center in Amsterdam, followed up with each woman participating in the trial.2 Through mailed questionnaires, they analyzed health-related quality of life, patient satisfaction, and treatment reintervention rates. Published earlier this year in the American Journal of Obstetrics and Gynecology, this study is the longest follow-up so far from a randomized comparison between UAE and hysterectomy.
Of the original 156 women, 131 responded and their feedback was compared to the original treatment outcomes. Based on the responses received, 35% (28 of 81) of the women who underwent UAE ended up having a hysterectomy (4 due to persisting symptoms, 1 due to a prolapsed uterus). Of these women, about 30% (24 out of 77) had what was considered a successful UAE procedure. These results indicate that about two-thirds of women undergoing UAE can avoid hysterectomy.
The 10-year outcomes also showed health-related quality of life scores to remain stable in both groups without any major differences. In each group, the majority of women (78% UAE versus 87% hysterectomy) said they were very satisfied with the treatment they received.
Given these results, the authors concluded UAE to be “a well-documented and less invasive alternative to hysterectomy” and that hysterectomy could be avoided in the majority of women treated with UAE
Although noncancerous, uterine fibroids can cause symptoms like heavy periods, pelvic pain, and incontinence. To treat symptoms, hysterectomy is currently the most common—and one of the most unnecessary—gynecological surgeries in the nation. An estimated 600,000 hysterectomies are performed annually, the majority—nearly 41%—to treat fibroids.3,4
Given the mounting clinical evidence surfacing in support of UAE for the treatment of symptomatic fibroids, Dr. de Bruijn and her team urged clinicians to counsel women with fibroids who are candidates for hysterectomy about the option of UAE.
ABOUT THE AUTHOR Alicia Armeli is a Health Freelance Writer, Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community. She is a paid consultant of Merit.
- Hehenkamp, W., Volkers, N., Donderwinkel, P., de Blok, S., Birnie, E., Ankum, W., & Reekers, J. (2005). Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): Peri- and postprocedural results from a randomized controlled trial. American Journal of Obstetrics And Gynecology, 193(5): 1618-1629. http://dx.doi.org/10.1016/j.ajog.2005.05.017
- de Bruijn, A., Ankum, W., Reekers, J., Birnie, E., van der Kooij, S., Volkers, N., & Hehenkamp, W. (2016). Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. American Journal of Obstetrics And Gynecology. doi: 10.1016/j.ajog.2016.06.051
- Centers for Disease Control and Prevention. (2016). Fact sheet: Hysterectomy in the United States, 2000–2004. Retrieved July 13, 2016, from http://www.cdc.gov/reproductivehealth/data_stats/
- The American Congress of Obstetricians and Gynecologists. (2011). Choosing the Route of Hysterectomy for Benign Disease. Retrieved July 13, 2016, from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Choosing-the-Route-of-Hysterectomy-for-Benign-Disease