A 38-year-old with a 7 cm intramural fibroid causing heavy menstrual bleeding has completed her family. She is counselled about uterine artery embolisation (UAE) versus myomectomy. According to the EMMY trial, what was the key finding regarding UAE compared to hysterectomy that informs counselling?

• A UAE had equivalent symptom relief at 2 years compared to hysterectomy but 28% of UAE patients required a second intervention (myomectomy/hysterectomy) within 5 years ✓
• B UAE had equivalent clinical success (symptom relief) at 5 years with lower major complication rate
• C UAE resulted in complete fibroid resolution equivalent to surgical myomectomy at 1 year
• D UAE was superior to hysterectomy in all outcomes and should be first-line for all fibroids

Explanation

The EMMY trial (Hehenkamp et al., 2008) was a randomised trial comparing UAE versus hysterectomy for symptomatic fibroids. At 2.5-year follow-up, symptom relief was equivalent, but approximately 28% of UAE patients required a secondary surgical intervention (most commonly hysterectomy) within 5 years due to recurrence or treatment failure. Hysterectomy provided definitive cure. UAE had a shorter hospital stay and faster recovery but higher re-intervention rate. This informs counselling: UAE is a valid uterine-sparing alternative but patients must be aware of the significant re-intervention rate, unlike hysterectomy which is definitive.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.