title: The incidence of hysterectomy, uterus-preserving procedures and recurrent treatment in the management of uterine fibroids.
abstract: OBJECTIVE
  To determine the incidence of hysterectomy and uterus-preserving procedures (UPPs) among women with uterine fibroids (UFs) and the incidence of further procedures after a UPP.
  
  
  METHODS
  This was an observational study using a primary care database, The Health Improvement Network (THIN). Women in THIN with UFs aged 15-54 years between January 2000 and December 2009 were eligible for study. The UPPs examined were myomectomy, endometrial ablation (EA) and uterine artery embolization (UAE). Using Read codes, women were followed up until one of the following was met: there was a record of hysterectomy or UPPs, they died or the study ended (end of 2010).
  
  
  RESULTS
  The cumulative incidence of hysterectomy or UPPs was 23.6% at 1 year, and 40.9% after the follow-up period (median 3.6 years). At the end of the follow-up period, the cumulative incidences of hysterectomy, myomectomy, EA and UAE were 33.0%, 3.9%, 6.4% and 1.9%, respectively. For women initially treated with a UPP, the cumulative incidence of second procedures was 11.5% at 1 year. At the end of the follow-up period (median 2.7 years), the cumulative incidence of further procedures was 26.1%, and the cumulative incidences of women undergoing hysterectomy, myomectomy, EA and UAE were 19.0%, 4.3%, 3.4% and 1.4%, respectively.
  
  
  CONCLUSIONS
  Women considering UPPs for the management of UFs should be made aware that the incidence of further treatments is high, with hysterectomy being the most frequent procedure undergone.
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain. Electronic address: elisaceife@gmail.com.
authors.forename: Elisa
authors.initials: E
authors.lastname: Martín-Merino
authors.affiliation: Spanish Centre for Pharmacoepidemiologic Research (CEIFE), Madrid, Spain.
authors.forename: Luis Alberto
authors.initials: LA
authors.lastname: García Rodríguez
authors.affiliation: Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.
authors.forename: Mari-Ann
authors.initials: MA
authors.lastname: Wallander
authors.affiliation: Bayer Pharma AG, Berlin, Germany.
authors.forename: Susan
authors.initials: S
authors.lastname: Andersson
authors.affiliation: Bayer Pharma AG, Berlin, Germany.
authors.forename: Monste
authors.initials: M
authors.lastname: Soriano-Gabarró
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D055356:Endometrial Ablation Techniques / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007889:Leiomyoma / Q000628:therapy*; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D010051:Ovarian Neoplasms / Q000628:therapy*; D010298:Parity; D019233:Retreatment / Q000706:statistics & numerical data; D055357:Uterine Artery Embolization / Q000706:statistics & numerical data; D063186:Uterine Myomectomy / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Hysterectomy; The Health Improvement Network; Uterine fibroids; Uterus-preserving procedures