Comparative Study of Medical and Surgical Management of Uterine Fibroids in Bangladesh

Abstract

Background: Uterine fibroids, also known as leiomyomas, are the most common benign tumors of the female reproductive system, affecting up to 70% of women by the age of 50. They are associated with various symptoms, including heavy menstrual bleeding, pelvic pain, and pressure symptoms, which can significantly impair quality of life. This study aims to compare the effectiveness of medical versus surgical management of symptomatic uterine fibroids. Methods: This prospective, comparative study was conducted in Maternity Center, Madhupur, Tangail, Bangladesh during the period from January 2021 to December 2021, Dhaka, Bangladesh, enrolled 107 women diagnosed with symptomatic uterine fibroids. Primary outcomes included symptom relief (heavy menstrual bleeding, pelvic pain, and pressure symptoms) at 6 months, treatment success rate, quality of life improvement (measured by the UFS-QoL questionnaire), and patient satisfaction. Data were collected at baseline and 6 months, and analyzed using SPSS version 25. Result: At the 6-month follow-up, symptom relief was notably higher in the surgical group for heavy menstrual bleeding (92.7% vs. 65.4%, p = 0.001), pelvic pain (89.1% vs. 52.1%, p = 0.002), and pressure symptoms (85.4% vs. 41.3%, p = 0.001). Surgical management also showed a higher overall treatment success rate (96.4% vs. 59.6%, p = 0.001), with a lower recurrence rate (3.6% vs. 28.8%, p = 0.001). Quality of life improvement, including symptom severity (21.3 ± 7.8 vs. 48.5 ± 9.2, p = 0.001) and health-related QoL (87.5 ± 8.9 vs. 63.2 ± 10.7, p = 0.001), was significantly better in the surgical group. Furthermore, patient satisfaction was much higher among surgical patients, with 81.8% reporting being very satisfied, compared to 38.5% in the medical group (p = 0.001). Conclusion: This study supports the superiority of surgical management for the treatment of uterine fibroids, especially in terms of symptom relief, treatment success, recurrence rates, and patient satisfaction. Although medical management remains a viable option, particularly for patients wishing to avoid surgery, the findings suggest that surgery offers more significant, long-lasting benefits in controlling symptoms and improving quality of life.