OP17.02: Quality of life after uterine artery embolisation versus hysterectomy for symptomatic adenomyosis: one‐year outcome from the QUESTA study

To demonstrate non-inferiority of uterine artery embolisation (UAE) on health-related quality of life (HRQOL) in comparison to hysterectomy in the treatment of symptomatic adenomyosis, one year after treatment. Twelve Dutch hospitals included patients with symptomatic adenomyosis eligible for hysterectomy. Patients were offered UAE as an alternative treatment option. Primary endpoint was the change in HRQOL between UAE and hysterectomy, measured with standardised WHO-QOL-Bref (physical, psychological, social and environmental domain) and SF-12 (mental and physical) questionnaires. UAE is considered non-inferior to hysterectomy when HRQOL does not differ more than 5 points. Secondary endpoints were a subsequent hysterectomy after UAE and changes in WHO-QOL100 facet Pain and Discomfort and facet Sexual Activity. Linear mixed models were used for the within and between group analyses, adjusted for relevant covariates. Of 101 patients, 51 underwent a hysterectomy and 50 a UAE. Both hysterectomy and UAE had a significant positive effect on all HRQOL scores, one year after intervention (all p < .05). There was no significant difference between the effect of UAE versus hysterectomy on HRQOL (all p > .05). Mean HRQOL difference of UAE versus hysterectomy at 1 year did not exceed 5 points. Both hysterectomy and UAE had a significant positive effect on facet Pain and Discomfort and facet Sexual Activity (both p < .001). However, hysterectomy had a greater effect on Pain and Discomfort than UAE (p = .002). Six patients (12%) underwent a subsequent hysterectomy in the first year after receiving UAE. UAE for symptomatic adenomyosis is considered non-inferior to hysterectomy one year after treatment in terms of health-related quality of life and could therefore be an effective and less-invasive alternative in the treatment for symptomatic adenomyosis. Nevertheless, when patients seek for a definitive solution hysterectomy remains the treatment of choice.