Title: Long-term health related quality of life following Uterine Fibroid Embolization 1 in a predominantly black African population: A retrospective Cohort study

Background: Uterine Fibroid Embolization (UFE) is one of the effective options available for treatment of symptomatic uterine fibroids with documented improvement in the quality of life and reduction in symptoms. Most of the studies have demonstrated an improvement in the quality of life over a short to intermediate period. We carried out this study to assess the long-term quality of life following uterine fibroid embolization in a predominantly black population. There are no identified studies locally or in Africa addressing this issue whereas studies done elsewhere indicate a probable increased fibroid disease burden among black women. Methods: This was a retrospective single cohort study that recruited patients who had UFE between 2009-2014. Study participants were sampled consecutively, invited to the study and asked to fill an online general demographic tool and the UFS-QOL. Wilcoxon signed rank tests were done to test for statistical significance between HRQOL scores. Pearson correlation analysis was carried out to evaluate possible association between various independent factors and specific outcomes of interest such as quality of life and symptom severity score. Results: Data was obtained from 77 participants. The median duration after the initial UFE was eight years. The median health related quality of life was 88.6 (62.9-98.3). This was statistically significant from baseline median scores of similar studies. The median symptom severity score decreased from a baseline score of 54.7 (43.8-65.6) to 21.9 (6.3-42.2). This decrease was statistically significant (p-value <0.001). Twenty-four participants (31.1%) reported follow up fibroid treatments after the initial UFE procedure. Eleven participants (14.3%) reported major repeat procedures (myomectomy, hysterectomy and UFE) .Seventeen participants (22%) reported a pregnancy after the UFE procedure with ten participants (13 %) reporting to have had children after the UFE procedure. Conclusion: UFE results in clinically sustained improvement in health related quality of life and symptom control among patients with uterine fibroids.