{"paper_id":"ddbfdceb-c086-411e-b02f-3694af341ac6","body_text":"Abstract\nPurpose of Review\nThis review will examine the use of uterine artery embolization (UAE) for the management of adenomyosis (AUB-A) and evaluate its advantages and disadvantages.\nRecent Findings\nIn the last 5 years, 8 articles have described UAE for the management of AUB-A. These include 2 prospective and 5 retrospective studies and 1 systematic review and meta-analysis. There are no randomised controlled trials for UAE as a treatment of adenomyosis. Recent data report a reduction in heavy menstrual bleeding (HMB) in 80–88% of patients and a reduction in dysmenorrhoea in 76–80% of those undergoing UAE. Quality of life is reported to be significantly improved and uterine volumes reduced following treatment. Disadvantages of UAE include post-procedural pain, adenomyoma extrusion, pyomyoma, Asherman syndrome, and requirement for further intervention including subsequent hysterectomy for management of pain or bleeding.\nSummary\nInitial non-randomised data support uterine artery embolization as an effective modality for the conservative management of AUB-A. The advantages of UAE include avoidance of abdominal surgery, significant improvement in symptoms, and quality of life scores and preservation of reproductive potential. To date, most data are retrospective with no randomised controlled studies and a few prospective analyses. Randomised controlled data are needed to comprehensively evaluate UAE as conservative treatment for AUB-A and to compare efficacy, cost, and durability of both medical and surgical treatments.\nSimilar content being viewed by others\nReferences\nPapers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance\nBird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus–revisited. Am J Obstet Gynecol. 1972;112(5):583–93.\nStratopoulou CA, Donnez J, Dolmans MM. Origin and pathogenic mechanisms of uterine adenomyosis: what is known so far. Reprod Sci. 2021;28(8):2087–97.\nMunro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393–408.\nLohle PNM, Higué D, Herbreteau D. Uterine artery embolisation in women with symptomatic adenomyosis. Presse Med. 2019;48(4):435–9.\nDonnez J, Donnez O, Dolmans MM. Introduction: uterine adenomyosis another enigmatic disease of our time. Fertil Steril. 2018;109(3):369–70.\nAbbott JA. Adenomyosis and abnormal uterine bleeding (AUB-A)-pathogenesis diagnosis and management. Best Pract Res Clin Obstet Gynaecol. 2017;40:68–81.\nVercellini P, Parazzini F, Oldani S, Panazza S, Bramante T, Crosignani PG. Adenomyosis at hysterectomy: a study on frequency distribution and patient characteristics. Hum Reprod. 1995;10(5):1160–2.\nDi Donato N, Montanari G, Benfenati A, Leonardi D, Bertoldo V, Monti G, et al. Prevalence of adenomyosis in women undergoing surgery for endometriosis. Eur J Obstet Gynecol Reprod Biol. 2014;181:289–93.\nVannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Res. 2019;8.\nBergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB. Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod. 2001;16(11):2418–21.\nBazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine J-M, et al. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod. 2001;16(11):2427–33.\nRavina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, et al. Arterial embolisation to treat uterine myomata. Lancet. 1995;346(8976):671–2.\nD’Hoore T, Timmerman D, Laenen A, Maleux G. Long-term outcome and pre-interventional predictors for late intervention after uterine fibroid embolization. Eur J Obstet Gynecol Reprod Biol. 2020;247:149–55.\nLaughlin-Tommaso S, Barnard EP, AbdElmagied AM, Vaughan LE, Weaver AL, Hesley GK, et al. FIRSTT study: randomized controlled trial of uterine artery embolization vs focused ultrasound surgery. Am J Obstet Gynecol. 2019;220(2):174.e1-174.e13.\nLacayo EA, Khera SS, Spies JB. Impact of patient and procedure-related factors on radiation exposure from uterine artery embolization. Cardiovasc Intervent Radiol. 2020;43(1):120–6.\nHan K, Kim SY, Kim HJ, Kwon JH, Kim GM, Lee J, et al. Nonspherical polyvinyl alcohol particles versus tris-acryl microspheres: randomized controlled trial comparing pain after uterine artery embolization for symptomatic fibroids. Radiology. 2021;298(2):458–65.\nKhayrutdinov E, Vorontsov I, Arablinskiy A, Shcherbakov D, Gromov D. A randomized comparison of transradial and transfemoral access in uterine artery embolization. Diagn Interv Radiol. 2021;27(1):59–64.\nHiminiuc LMM, Murarasu M, Toma B, Popovici R, Grigore AM, Scripcariu IS, et al. Transradial embolization, an underused type of uterine artery embolization approach: a systematic review. Medicina. 2021;57(2):83.\nZhou J, He L, Liu P, Duan H, Zhang H, Li W, et al. Outcomes in adenomyosis treated with uterine artery embolization are associated with lesion vascularity: a long-term follow-up study of 252 cases. PLoS One. 2016;11(11):e0165610.\n• Liang E, Brown B, Rachinsky M. A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: Results in 117 women. Aust N Z J Obstet Gynaecol. 2018;58(4):454–9. Findings in this study demonstrate symptom reduction and improved QoL scores at long-term follow-up.\nWang S, Meng X, Dong Y. The evaluation of uterine artery embolization as a nonsurgical treatment option for adenomyosis. Int J Gynaecol Obstet. 2016;133(2):202–5.\nde Bruijn AM, Smink M, Lohle PNM, Huirne JAF, Twisk JWR, Wong C, et al. Uterine artery embolization for the treatment of adenomyosis: a systematic review and meta-analysis. J Vasc Interv Radiol. 2017;28(12):1629–42.\nZheng R, Zeng D, Wan TT, Guo WB, Guo Y, Liu MJ. Predisposing factors for predicting the therapeutic response of adenomyosis after uterine artery embolization: serum CA125 levels and accompanying endometriosis. Diagn Interv Radiol. 2018;24(6):364–71.\nGuo W, Hu S, Zeng D, Yan C, Zheng R, Gao J, et al. The prognostic role of ovarian endometriosis in symptomatic adenomyosis patients underwent uterine artery embolization. Ann Palliat Med. 2021;10(3):2577–83.\n•• Wang Y, Lyu W, Xu W, Yu Y. Asherman syndrome in adenomyosis treated with uterine artery embolization: incidence predictive factors. Radiol Med. 2020;125(5):437–43. Findings in this study suggest that decreased lesion vascularity at the time of embolization increases the risk of subsequent intrauterine synechiae formation.\nGynaecologists TRAaNZCoOa. Uterine artery embolisation for the treatment of uterine fibroids. C-Gyn 23. 2020.\nACOG Committee Opinion. Uterine artery embolization. Obstet Gynecol. 2004;103(2):403–4.\nDessouky R, Gamil SA, Nada MG, Mousa R, Libda Y. Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy. Insights Imaging. 2019;10(1):48.\nEl Shamy T, Amer SAK, Mohamed AA, James C, Jayaprakasan K. The impact of uterine artery embolization on ovarian reserve: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2020;99(1):16–23.\nde Bruijn AM, Smink M, Hehenkamp WJK, Nijenhuis RJ, Smeets AJ, Boekkooi F, et al. Uterine artery embolization for symptomatic adenomyosis: 7-year clinical follow-up using UFS-Qol questionnaire. Cardiovasc Intervent Radiol. 2017;40(9):1344–50.\nSaibudeen A, Makris GC, Elzein A, Wigham A, Patel R, Husainy MA, et al. Pain management protocols during uterine fibroid embolisation: a systematic review of the evidence. Cardiovasc Intervent Radiol. 2019;42(12):1663–77.\nKim SY, Koo BN, Shin CS, Ban M, Han K, Kim MD. The effects of single-dose dexamethasone on inflammatory response and pain after uterine artery embolisation for symptomatic fibroids or adenomyosis: a randomised controlled study. BJOG. 2016;123(4):580–7.\nKim MD. Uterine artery embolization for leiomyomas and adenomyosis: a pictorial essay based on our experience from 1300 cases. Korean J Radiol. 2019;20(10):1462–73.\nAcknowledgements\nThanks are given to Dr. Eisen Liang, Interventional Radiologist, Sydney Adventist Hospital, for the images presented in Fig. 1.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nConflict of Interest\nThe authors declare no conflicts of interest relevant to this manuscript.\nHuman and Animal Rights and Informed Consent\nThis article does not contain any studies with human or animal subjects performed by any of the authors.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nThis article is part of the Topical Collection on Uterine Fibroids and Endometrial Lesions\nRights and permissions\nAbout this article\nCite this article\nKnapman, B.L., Abbott, J. & Vyas, M.A. The Advantages and Disadvantages of Uterine Artery Embolization in Women with Adenomyosis: What’s New?. Curr Obstet Gynecol Rep 10, 92–100 (2021). https://doi.org/10.1007/s13669-021-00309-0\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s13669-021-00309-0","source_license":"CC0","license_restricted":false}