Women's decision-making determinants in choosing uterine artery embolization for symptomatic fibroids.

OBJECTIVE: To determine what symptoms of leiomyomata uteri prompted women to seek uterine artery embolization (UAE) and what factors were most frequently cited in the decision making leading to choosing UAE over other treatments. STUDY DESIGN: Eighty-four consecutive women with symptomatic leiomyoma presenting for UAE completed a questionnaire that inquired about their pelvic symptoms and the issues that were important in their decision to request UAE. All subjects previously had been told that they were surgical candidates. RESULTS: Pelvic symptoms that the 84 women most frequently noted were bleeding (n = 61), anemia (41), pelvic pain (29), frequent urination (24) and pelvic pressure (21). The majority of women (78) reported significant worry about their health from the fibroids, and (72) reported that the symptoms caused daily discomfort. Although the majority of women wanted a treatment that would give permanent relief of symptoms and thought UAE would do this, other factors frequently cited in the decision making included quality-of-life reasons, such as the desire to avoid adverse effects of other treatments (76), anticipated prolonged postoperative recovery from surgery (70) and avoiding surgery (66). Many women considered the uterus an important female organ, believed that the uterus was a source of femininity (33), stated that the uterus was necessary to maintain self-image (49) and reported that the uterus was necessary to maintain sexual image (49). CONCLUSION: In this cohort of women with symptomatic leiomyomas, treatment preferences did not interfere with the current lifestyle. In addition, the uterus was considered a source of femininity and sexuality. It is not clear whether women requesting UAE differ from women requesting surgical intervention in terms of how they assess the importance of the uterus, but these data suggest that many women still consider the uterus an important aspect of their femininity and that those seeking nonsurgical options should be thoroughly counseled about uterine function and how it relates to sexuality.