# Nationwide analysis of surgical and interventional uterine fibroid treatments over the past decades in Germany

## TL;DR

This study analyzes the use of surgical and interventional treatments for uterine fibroids in Germany from 2005 to 2023, showing a decline in invasive procedures and minimal use of UAE.

## Contribution

The study provides the first nationwide analysis of uterine fibroid treatment trends in Germany over nearly two decades.

## Key findings

- Hospitalizations for uterine fibroid treatments decreased by 47.7% from 2005 to 2023.
- Uterine artery embolization (UAE) was used in less than 1% of cases, with a peak in 2012 followed by a decline.
- Surgery remained the dominant treatment, with over 99% of patients undergoing surgical procedures.

## Abstract

Uterine artery embolization (UAE) has been a valid tool in the treatment of symptomatic uterine fibroids for a quarter of a century by now. This study aims to examine the impact of this treatment and its development since its introduction in Germany.

All patients that received inpatient treatment for uterine fibroids (ICD-10 code D25) as primary diagnosis or the primary symptoms of hypermenorrhea/menorrhagia (N92) or dysmenorrhea (N94) with a secondary diagnosis of uterine fibroids from 2005 until 2023 were included. The data was obtained from the research data center of the German Federal Statistical Office. Basic demographic data and all encoded diagnostic and therapeutic procedures were collected and analyzed. Special focus laid on patients receiving either of the three invasive treatments: hysterectomy (HE), myomectomy (ME), and uterine artery embolization (UAE).

One million one hundred sixty-four thousand five hundred sixty-six women were hospitalized in those 19 years with 91.7% receiving either HE, ME or UAE. There was a continuous decline in annual numbers of hospitalizations (-47.7%) and of HE (-55.5%) between 2005 and 2023. Constantly more than 99% of the treated women underwent surgery—contribution of UAE continuously remained below 1%. The highest number of UAE was conducted in 2012 with 568 treated women, followed by a continuous decline to 313 in 2023. The reference population of all women at the age of 30 to < 55 years in Germany decreased only slightly from 15,230,000 to 13,506,000 (-11.3%).

The numbers of inpatient invasive treatment continuously declined disproportionately to the demographic development. Despite excellent evidence, UAE is not used for treatment of symptomatic uterine fibroids to a relevant extent in Germany.