Uterine Artery Embolisation for Adenomyosis - Current Evidence and Practice

Genital / Reproductive system female, Management, Catheter arteriography, Embolisation, Other Authors: W. Yeung, M. Lukies, M. Lukies DOI: 10.26044/ranzcr2025/C-26 Learning objectives Learning ObjectivesTo review current literature surrounding efficacy and practice of uterine artery embolisation (UAE) for adenomyosis

BackgroundAdenomyosis is a benign gynaecological condition where endometrial glands and stroma are present in the myometrium. While some patients may be asymptomatic with adenomyosis, others report pelvic pain, menorrhagia, infertility and pregnancy loss. Current conservative management of the menorrhagia and pain associated with adenomyosis includes use of tranexamic acid, non-steroidal anti-inflammatory drugs (NSAIDs), combined oral contraceptive pills (COCP) and levonorgestrel-releasing intrauterine devices (IUD). When conservative treatment is inadequate, many women are offered a hysterectomy as definitive management.1 Recent evidence has demonstrated the effectiveness of uterine... Imaging findings OR Procedure details Imaging FindingsAfter clinical consultation and workup, patients with suspected adenomyosis should be radiologically evaluated with either a transvaginal ultrasound (TVUS) or magnetic resonance imaging (MRI). These modalities help to quantify endometrial thickness and presence of any cysts both of which contribute to the diagnosis of adenomyosis. TVUS is more readily available and associated with a lower cost, and is commonly sufficient for diagnosis and follow-up of adenomyosis, however, MRI can provides greater detail about disease extent and vascular supply.8Key findings on US9Direct indicators of adenomyosis...

LimitationsAlthough current literature reports good efficacy of UAE for adenomyosis, the level of evidence is “fair” as per USPSTF criteria. To date, there has been no randomised controlled trial comparing UAE to hysterectomy specifically for adenomyosis.There is no formally agreed upon selection criteria for UAE in adenomyosis but many have explored different characteristics such as vascularity, imaging findings and presentation. Some evidence states that patients with hypervascular, focal adenomyotic lesions tend to report more improved symptomatology than those with a thicker pre-treatment junctional zone.14 Kim...

1. 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 Aug;58(4):454-459. doi: 10.1111/ajo.12767. Epub 2018 Jan 18. PMID: 29344938.2. Dason, E. S., Maxim, M., Sanders, A., Papillon-Smith, J., Ng, D., Chan, C., & Sobel, M. (2023). Guideline No. 437: Diagnosis and Management of Adenomyosis. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 45(6),...