Adenomyosis Embolization

Background and indications

Adenomyosis is a common gynecological condition in which endometrial tissue (the lining that normally covers the inside of the uterus) grows within the myometrium (uterine muscular wall). It affects approximately 20-35% of women and presents with heavy and painful periods (dysmenorrhea), chronic pelvic pain, intermenstrual bleeding, and sometimes infertility or recurrent miscarriages.

Uterine artery embolization is offered as a minimally invasive alternative to hysterectomy for symptomatic women wishing to preserve their uterus or with surgical contraindications. It is also considered after failure of medical treatment (progestins, levonorgestrel IUD, GnRH analogues).

Pre-procedure assessment

Assessment relies on pelvic MRI, the reference examination to confirm adenomyosis diagnosis (junctional zone thickness > 12 mm, intramyometrial microcysts), distinguish it from fibroids, and evaluate its extent (focal or diffuse). Pelvic ultrasound, blood tests (CBC, ferritin) and a gynecological consultation complete the workup.

Procedure

The technique is identical to uterine fibroid embolization. Under local anesthesia and sedation or epidural, a microcatheter is introduced through the femoral or radial artery. Both uterine arteries are catheterized and embolized with calibrated microspheres. The goal is to reduce the blood supply to adenomyotic tissue, causing partial necrosis and uterine volume reduction. The procedure takes approximately 45 to 90 minutes.

Results and scientific evidence

Available data show significant symptom improvement in 65-75% of adenomyosis cases treated by embolization, with a 25-40% uterine volume reduction at 12 months. Menorrhagia improvement is observed in 75-85% of cases and dysmenorrhea improvement in 60-70% of cases (Kim et al., CardioVascular and Interventional Radiology, 2020; DOI: 10.1007/s00270-019-02404-7).

Long-term results suggest a reintervention rate (hysterectomy) of approximately 20-25% at 5 years, mainly in cases of severe diffuse adenomyosis. Focal adenomyosis generally responds better to embolization than diffuse forms.

Risks and complications

The complication profile is similar to fibroid embolization: post-embolization syndrome (pain, nausea, fever) in the first 24-72 hours, managed with analgesics. Uterine infection (< 2%), transient or permanent amenorrhea (rare before age 45). Major complications are exceptional.

Recovery

Hospitalization is typically 1-2 nights. Return to activities is possible after 1 to 2 weeks. Symptom improvement is gradual over 3 to 6 months. Follow-up includes MRI at 6 and 12 months.

Practical information

The procedure is performed as a short inpatient stay or outpatient depending on the case. It is performed by an interventional radiologist, in coordination with the treating gynecologist.