Changes in rates of hysterectomy and uterine conserving procedures for treatment of uterine leiomyoma

Objective The purpose of this study was to investigate treatment of uterine leiomyoma by hysterectomy and uterine conserving procedures (UCPs). Study Design Data from Kaiser Permanente Northern California members undergoing hysterectomy, myomectomy, uterine artery embolization (UAE) and endometrial ablation (EA) for uterine leiomyoma from 1997-2003 were collected. Statistical analysis included trend tests and survival analysis. Results Hysterectomy rates for leiomyoma decreased significantly from 2.13 per 1000 to 1.91 ( P < .0001). Rates for myomectomy (.4-.37) and EA (.26-.27) remained stable ( P = .17 and .26, respectively), whereas rates for UAE increased significantly from < .01-.24 ( P < .0001). The combined rates for hysterectomy and UCPs remained stable at 2.79 ( P = .95). Rate of hysterectomy after UCP increased over time, and at 6 years reached 11.5%, 17.7%, and 7.9% for EA, UAE, and myomectomy, respectively. Conclusion Whereas rate of hysterectomy for leiomyoma decreased, total rate of invasive treatment remained stable. Increase in rate of UAE had the greatest impact on treatment, possibly replacing hysterectomy.