Women’s health before and after myomectomy

Introduction. Recently, special attention has been paid to the quality of life of women and its changes after myomectomy. Aim. To assess the effect of myomectomy on menstrual function and quality of life in women with uterine fibroids. Materials and methods. A prospective clinical observational study was carried out at the clinical sites of the Department of Obstetrics and Gynecology with a course of perinatology at the Medical Institute of the RUDN University named after. Patrice Lumumba. Women of reproductive age with uterine fibroids (n = 80) and indications for organ-preserving treatment were selected, their complaints, general and obstetric-gynecological anamnesis, clinical, laboratory and instrumental studies of the patients were analyzed. The UFS-QOL questionnaire developed by the SIR Foundation was used to assess the severity of uterine fibroid symptoms and quality of life. Accumulation, adjustment, systematization of source information and statistical analysis were carried out using the IBM SPSS Statistics v. 23 program (IBM Corporation). Results. The average age of women with uterine fibroids was 40.36 ± 4.5 (27–49) years. During surgery, one myomatous node was removed in 61 (76.3%) women; in the rest, from 2 to 7 myomas were removed. Localization of removed fibroids according to the classification of The International Federation of Gynecology and Obstetrics 2018 (FIGO): in 3 (3.75%) women it was classified as type 7 according to FIGO – in 1 patient the node was isthmus, in 2 it was intraligamentous. The size of the identified fibroids varied from 0.5 cm to 15 cm (3.78 ± 3.0). 50% of patients with uterine fibroids had heavy menstruation, and 27.5% were diagnosed with iron deficiency anemia. When assessing the average severity of symptoms of uterine fibroids before and after myomectomy, it was found to decrease from 31.46 ± 20.0 (0–93.75) to 14.91 ± 17.1 (0–84.37) (p < 0.001). The HRQL total quality of life score also increased from 71.14 ± 20.7 (22.41–100) to 82.05 ± 17.6 (30.17–100) (p < 0.001). The number of women after myomectomy with a total HRQL level of more than 75 increased statistically significantly by 27.5% and decreased by 20% in the range of 50–75 (p < 0.05). However, when analyzing the results of the UFS-QOL questionnaires, it was found that in 7 (8.75%) patients the quality of life did not change before and after myomectomy, and in 12 (15%) women, despite a decrease in the severity of symptoms of uterine fibroids after myomectomy, quality of life (HRQL total) became slightly lower (Wilcoxon test 129.5, p = 0.242). 6 (7.5%) women experienced worsening symptoms of uterine fibroids after surgery: 25.52 ± 11.4 (9.38–43.75) before myomectomy and 33.33 ± 13.6 (12.5–50) after (Wilcoxon test 30, p = 0.146). Conclusions. Myomectomy did not always lead to healthier women and an improvement in their quality of life. Further research in this area is required.