Uterine Artery Embolisation for Adenomyosis in Women Who Failed Prior Endometrial Ablation

Uterine Artery Embolisation for Adenomyosis in Women Who Failed Prior Endometrial Ablation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Uterine Artery Embolisation for Adenomyosis in Women Who Failed Prior Endometrial Ablation Eisen Liang, Razeen Parvez, Sylvia Ng, Bevan Brown This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4268436/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Jul, 2024 Read the published version in CVIR Endovascular → Version 1 posted 5 You are reading this latest preprint version Abstract Purpose: To report the effectiveness of uterine artery embolisation (UAE) in treating adenomyosis in women who failed prior endometrial ablation (EA). Materials and Methods: This is a retrospective cohort study. Medical records of women who had UAE for adenomyosis over a five-year period were reviewed to identify women who had failed prior endometrial ablation (EA). A 2-part electronic survey was sent to these women: Part 1 inquired about changes in menstrual heaviness, period pain, menopausal status, overall satisfaction, and requirement for further intervention. Part 2 consisted of the Uterine Fibroid Symptom and Quality of Life Survey (UFSQoL). Pain score, number of days in pain, MRI uterine volume, junctional zone thickness, and Symptom and QoL scores before and after UAE were compared. Results: Eighteen women who had undergone EA prior to UAE were identified. One was lost to follow-up, leaving 17 women available for review, with a mean follow-up of 1.6 years (range 0.6 to 3 years). The mean reduction in pain score was 6.29, the mean reduction in symptom score was 32.1, and the mean QoL improvement was 39, all significant (P<0.0001). Improvement in menorrhagia was reported in 7/8 (87.5%) women. Fifteen (88.2%) women were satisfied with the outcome. Only 1/17 (5.9%) women proceeded to hysterectomy. Mean uterine volume reduction was from 189.7 mL to 123.3 mL. Mean junctional zone reduction was from 17.9 mm to 14.0 mm. No complications were noted in this audit. Conclusion: UAE is effective in managing adenomyosis in women who failed prior endometrial ablation, with significant improvement in dysmenorrhea and heavy menstrual bleeding. Figures Figure 1 Purpose To report the effectiveness of uterine artery embolisation (UAE) in treating adenomyosis in women who failed prior endometrial ablation (EA). Introduction Endometrial ablation (EA) is a minimally invasive treatment for heavy menstrual bleeding (HMB). Patient satisfaction rates for EA are around 80–90%; however, about 10–20% of women require additional surgery (re-ablation or hysterectomy) due to persistent bleeding or pain [1]. Women with adenomyosis are more likely to fail EA [2]. Those with unsatisfactory outcomes from EA may be offered hysterectomy as their only remaining treatment option. Case series and meta-analyses have demonstrated that UAE is effective in alleviating adenomyosis-related HMB and dysmenorrhea [3, 4]. However, the effectiveness of UAE in treating women who failed prior EA has not been previously reported. This is a retrospective cohort study of the outcome of UAE for adenomyosis in women who failed previous EA. Materials and Methods This study was approved by the institutional Human Research Ethics Committee. Informed consent was obtained from each participant. Women presenting to our clinic with significant dysmenorrhea and/or HMB following unsatisfactory endometrial ablation were offered UAE as an alternative to hysterectomy. Medical records of women who had UAE for adenomyosis at our institution between January 2017 and March 2022 were reviewed to identify those who had EA prior to UAE. All women had pre-UAE MRI to confirm the presence of adenomyosis, diagnosed based on previously published criteria: junctional zone thickness of ≥12mm or >40% of myometrial thickness, or the presence of T2 hyperintense cysts/foci/fissuring [5]. All UAE procedures were performed with polyvinyl alcohol (PVA) particles, with sizes starting at 150 or 250 microns, as previously described [3]. To evaluate the clinical outcome, a 2-part online survey was sent to women to complete. Part 1 inquired about symptoms, menopausal status, overall satisfaction, and requirement for further intervention (Appendix 1). Women who had heavy menstrual bleeding prior to UAE were asked about their periods at the time of the audit. Overall success rate of UAE was assessed by asking women if they were “Very Happy,” “Happy,” “Not sure,” “Not Happy,” or “Very Unhappy” about the outcome. Only women who rated “Very Happy” or “Happy” were regarded as overall successful. Part 2 consisted of the validated Uterine Fibroid Symptom and Quality of Life Survey (UFSQoL) [6]. The following parameters before UAE and at follow-up were recorded and compared: dysmenorrhea visual analogue scale (VAS) pain score, number of days with dysmenorrhea, symptom score, and QoL score (using UFSQoL). Uterine volume and junctional zone thickness at baseline MRI and 6 months follow-up were compared. Significance of changes before and after treatment was analyzed using T-tests. Results Between January 2017 and March 2022, UAE procedures were performed in 270 women for adenomyosis, some of whom also had fibroids. Eighteen women were identified with prior ablation failure (see Table 1): 15 with pure adenomyosis and 3 with coexisting fibroids. One woman was lost to follow-up; the outcomes of 17/18 (94.4%) were available for analysis, at a mean follow-up of 1.6 years post-UAE (median 2, range 0.6–3 years). Significant reductions in pain score (VAS 6.29), number of days in pain (2.6 days), symptom score (32.1/100), and significant improvement in QoL (39/100) were noted (Table 2a). For the 8 women who still had HMB post-ablation, 7 (87.5%) saw significant improvement. Overall, 15/17 patients (88.2%) were “Happy” or “Very Happy” with the outcome of the UAE procedure (Chart 1). Only 1 (5.9%) woman required a hysterectomy. No other women required further intervention such as laparoscopy for residual pain/endometriosis. No immediate or long-term complications were noted in this audit. Thirteen women (76.5%) attended follow-up imaging (Figure 1). Significant uterine volume reduction and JZ thickness reduction were noted (Table 2a). Discussion This study has shown that UAE can be an effective treatment for post-ablation adenomyosis, with significant improvement in pain and residual HMB. Overall patient satisfaction is 88.2%, and 94.1% were able to avoid a hysterectomy. The results from this post-ablation failure cohort compare favourably with previously reported overall UAE outcomes for adenomyosis [3, 4]. The question of whether EA should be used to treat adenomyosis should be raised. Depth of involvement of adenomyosis has been shown to be associated with endometrial ablation failure [7]. Deep adenomyosis (>2.5 mm) is present in a significant number of women who underwent hysterectomy after failed endometrial ablation [8]. EA devices are designed to cause thermal destruction of 4-6 mm depth of tissue to the basalis level [9]. MRI diagnosis of adenomyosis requires junctional zone thickness of 12 mm or more [5]. Therefore, if the diagnosis of adenomyosis is established based on MRI criteria, there is a high chance that endometrial ablation might fail. We argue that if adenomyosis is established on imaging, UAE instead of EA should be offered to women as an alternative to hysterectomy. Previous studies suggest that ablation either activates surviving endometrial tissue to penetrate the myometrium, causing adenomyosis, or activates embedded ectopic endometrial glands to grow deeper into the myometrium, resulting in deeper adenomyosis [10]. This might explain dysmenorrhea as a main clinical feature of EA failure that requires further intervention. Women with dysmenorrhea might have endometriosis and/or adenomyosis and are therefore at risk of persistent pelvic pain after endometrial ablation, which treats neither of the two underlying conditions. The presence of pre-existing dysmenorrhea is the most strongly correlated risk factor for receiving a surgical reintervention such as hysterectomy [1]. Women’s health practitioners should be aware that failure to correctly diagnose adenomyosis might result in the inadvertent use of ablation, leading to further intervention. Improved diagnostic accuracy of adenomyosis may reduce the number of women undergoing inappropriate ablation. This might require wider use of MRI, which has a higher sensitivity and specificity than ultrasound in diagnosing adenomyosis [11]. This is a small retrospective cohort study. The average follow-up of 1.6 years remains short, and the longer-term hysterectomy rate is yet to be defined by future studies. It is not known if the adenomyosis was present prior to EA or developed subsequent to EA. There is no pathological proof of the underlying pathology being treated by UAE. Future studies could be designed to use MRI to document the absence of adenomyosis prior to EA and see if there is a reduction in EA failure rate. Conclusions UAE is safe and effective in managing women who failed endometrial ablation, with significant improvement in dysmenorrhea and heavy menstrual bleeding. Most women were able to avoid hysterectomy following UAE for ablation failure. Declarations - Ethical Approval and Consent to participate Informed consent was obtained from all individual participants involved in the study. This study was approved by the Adventist HealthCare Limited Human Research Ethics Committee (HREC 2022-028) - Consent for publication We consent for publication in CVIR Endovascular - Availability of data and materials Data is available for review upon request - Competing interests There is no conflict of interest identified. - Funding There was no financial support from outside organisation. - Authors' contributions Authors' contribution are as follows: Eisen Liang’s role: design concept, ethics submission data collection, literature review, drafting of paper, submission. Razeen Parvez’s role: data collection, data analysis, literature search, ethics submission Sylvia Ng’s role: data analysis, literature search, drafting / formatting/ referencing, Bevan Brown’s role: design concept, literature review, review of draft and editing. - Acknowledgements No special acknowledgements - Authors' information Eisen Liang: Interventional Radiologist Razeen Parvez: Research Assistant, Medical student Sylvia Ng: Research Assistant, Radiology Trainee Bevan Brown: Gynaecologist References Beelen, P. P., Reinders, W. I. M., Scheepers, C. F. W. M., Herman, J. M., Geomini, P. M. A., Van Kuijk, Y. M. C. M., & Bongers, M. Y. (2019). Prognostic Factors for the Failure of Endometrial Ablation: A Systematic Review and Meta-analysis. Obstetrics & Gynecology, 134 (6), 1269-1281. Mengerink, B. B., van der Wurff, A. A. M., ter Haar, J. F., van Rooij, I. A., & Pijnenborg, J. M. A. (2015). Effect of Undiagnosed Deep Adenomyosis After Failed NovaSure Endometrial Ablation. Journal of Minimally Invasive Gynecology, 22 , 239–244. de Bruijn, A. M., Smink, M., Lohle, P. N. M., Huirne, J. A. F., Twisk, J. W. R., Wong, C., Schoonmade, L., & Hehenkamp, W. J. K. (2017). Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis. Journal of Vascular and Interventional Radiology, 28 , 1629-1642. Liang, E., Brown, B., & Rachinski, M. (2018). A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: Results in 117 women. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58 , 454-459. Agostinho, L., Cruz, R., Osório, F., Alves, J., Setúbal, A., & Guerra, A. (2017). MRI for adenomyosis: a pictorial review. Insights into Imaging . DOI: 10.1007/s13244-017-0576-z Spies, J. B., Coyne, K., Guaou Guaou, N., et al. (2002). The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstetrics and Gynecology, 99 (2), 290-300. McCausland, A. M., & McCausland, V. M. (1996). Depth of endometrial penetration in adenomyosis helps determine outcome of rollerball ablation. American Journal of Obstetrics and Gynecology, 174 , 1786–1794. Mengerink, B. B., van der Wurff, A. A. M., ter Haar, J. F., van Rooij, I. A., & Pijnenborg, J. M. A. (2015). Effect of Undiagnosed Deep Adenomyosis After Failed NovaSure Endometrial Ablation. Journal of Minimally Invasive Gynecology, 22 , 239–244. Daub, C. A., Sepmeyer, J. A., Hathuc, V., Sakala, M. D., Caserta, M. P., Clingan, M. J., & Hosseinzadeh, K. (2015). Endometrial Ablation: Normal Imaging Appearance and Delayed Complications. American Journal of Roentgenology, 205 (4). McCausland, A. M., & McCausland, V. M. (1996). Depth of endometrial penetration in adenomyosis helps determine outcome of rollerball ablation. American Journal of Obstetrics and Gynecology, 174 , 1786–1794. Champaneria, R., Abedin, P., Daniels, J., Balogun, M., & Khan, K. S. (2010). Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstetricia et Gynecologica Scandinavica, 89 (11), 1374-1384. Tables Table 1: Baseline Parameters Baseline parameters Mean Median Range Age at time of procedure (years) 42.8 42.5 34–53 Age at time of UAE 47.7 49 40-54 Time gap between Ablation and UAE (years) 5.2 3.5 0.4–14 No of patients with Residual HMB post ablation (%) 8 (47%) - - VAS Pain score post ablation 8.1 9 0–10 Number of days in pain post ablation 2.7 2 0-10 MRI Uterine volume prior to UAE (cc) 189.7 178 62–427 MRI JZ thickness prior to UAE (mm) 19.1 20 12–25 Table 2a: Results: changes against baseline Reduction of mean VAS dysmenorrhea pain score 6.29, (P <0.0001) From 8.1 (median 9, range 0–10) to 1.9 (median 1, range 0–5) Reduction of number of days in dysmenorrhea 2.6 From 2.7 (median 2, range 10) to 0.1 (median 0, range 2) Improvement of mean UFS symptom score 32.1, (P <0.0001) From 51.4 (median 53.13, range 25–100) to 19.3 (median 12.5, range 0–78.1) Improvement of mean UFS QoL score 39.0, (P <0.0001) From 46.0 (median 56.0, range 2.6–80.2) to 84.9 (median 94.0, range 33.6–100) Improvement in menorrhagia (n=8) (BTN, LTN, LTE) 7 (87.5%) Clinical success (Happy or Very Happy with outcome) 15/17 patients (88.2%) Mean Uterine volume reduction (mL) 66.5(35.1%), (P <0.001) From 189.7 (median 178, range 62–427) to 123.3 (median 90, range 36–242) Mean JZ thickness reduction (mm) 3.9 (P <0.003) From 17.9 (median 16, range 6 -24) to 14 (median 11, range 8 to 27) Chart 1 Chart 1 is available in the Supplementary Files section. Supplementary Files Chart1.jpg Chart 1a Results: Menstrual bleeding Post UAE Chart 1b Results: Overall outcome 3.Adenomyosisauditquestionnaire2023.pdf Cite Share Download PDF Status: Published Journal Publication published 27 Jul, 2024 Read the published version in CVIR Endovascular → Version 1 posted Editorial decision: Minor revision 05 Jul, 2024 Reviewers agreed at journal 14 Jun, 2024 Reviewers invited by journal 14 Jun, 2024 Editor assigned by journal 11 Jun, 2024 First submitted to journal 08 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4268436","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":314470153,"identity":"a74d384c-8b35-4c2a-8fc8-c68b342fe2f5","order_by":0,"name":"Eisen Liang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYDACZhBRIAFiHQASEjJEajEAaWFLAGnhIdIqAxDBAyEJKuZnZ3/4uMDAQt6cf83nVzdqLHgY2A8f3YBPi2Qzj7HxDAMJw50z3m6zzjkGdBhPWtoNvE46zMMmzWMgwbjhxtltxjlsQC0SPGZ4tdgfZn/+G6jFfsONM8+Mc/4RocWAmcGMGaglccP5HubHuW1EaJE4zGMMcljyhhtsZsy5fRI8bIT8wt9//OFnnoo62w3nDz/+nPOtTo6f/fAxvFqQ7EtgA0UoAxtxysH2HWD+QLzqUTAKRsEoGEkAAN1nQQ6H2lApAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-0306-4133","institution":"Sydney Fibroid Clinic","correspondingAuthor":true,"prefix":"","firstName":"Eisen","middleName":"","lastName":"Liang","suffix":""},{"id":314470154,"identity":"bfba22a4-f9cf-4c83-b528-d65c58212558","order_by":1,"name":"Razeen Parvez","email":"","orcid":"","institution":"Sydney Fibroid Clinic","correspondingAuthor":false,"prefix":"","firstName":"Razeen","middleName":"","lastName":"Parvez","suffix":""},{"id":314470155,"identity":"e4ef5887-b5c9-464c-b0ff-cc234a01591d","order_by":2,"name":"Sylvia Ng","email":"","orcid":"","institution":"Gosford Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sylvia","middleName":"","lastName":"Ng","suffix":""},{"id":314470156,"identity":"39efab3f-34bb-433a-8b1a-391d07868f13","order_by":3,"name":"Bevan Brown","email":"","orcid":"","institution":"Sydney Fibroid Clinic","correspondingAuthor":false,"prefix":"","firstName":"Bevan","middleName":"","lastName":"Brown","suffix":""}],"badges":[],"createdAt":"2024-04-15 08:50:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4268436/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4268436/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s42155-024-00471-5","type":"published","date":"2024-07-27T16:16:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60511991,"identity":"12718278-1669-4f97-b644-97c2210691fc","added_by":"auto","created_at":"2024-07-17 14:39:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":121983,"visible":true,"origin":"","legend":"\u003cp\u003eMRI of a 50-year-old woman who had endometrial ablation 10 months ago but was still suffering from heavy menstrual bleeding and severe dysmenorrhea. Following UAE, she had regular periods with lightest-ever bleeding and a reduction of pain score from 10 to 1. Sagittal T2 MRI pre- and post-embolisation demonstrated a reduction of uterine volume from 210mL to 97mL, reduction of junctional zone from 21mm to 14mm, less bulging globular appearance, and marked reduction of myometrial cystic spaces (ectopic endometrial tissue).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4268436/v1/aff6f3b93ab1a74334a3a96a.jpg"},{"id":61596252,"identity":"a66d7595-f488-4ebf-abd9-e13119ee4d95","added_by":"auto","created_at":"2024-08-01 17:26:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":447227,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4268436/v1/bd8413cd-041a-4637-9b74-897670726ae0.pdf"},{"id":60511993,"identity":"fbac0ff5-06a6-4b2b-9f47-041607c97316","added_by":"auto","created_at":"2024-07-17 14:39:26","extension":"jpg","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":49728,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eChart 1a Results: Menstrual bleeding Post UAE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChart 1b Results: Overall outcome\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Chart1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4268436/v1/73f312b2132b9fec69c96933.jpg"},{"id":60511992,"identity":"9917b9ad-251e-42bb-a205-a32c6956dc65","added_by":"auto","created_at":"2024-07-17 14:39:25","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":73024,"visible":true,"origin":"","legend":"","description":"","filename":"3.Adenomyosisauditquestionnaire2023.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4268436/v1/dcec5b89077603403fa86cc6.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eUterine Artery Embolisation for Adenomyosis in Women Who Failed Prior Endometrial Ablation\u003c/p\u003e","fulltext":[{"header":"Purpose","content":"\u003cp\u003eTo report the effectiveness of uterine artery embolisation (UAE) in treating adenomyosis in women who failed prior endometrial ablation (EA).\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eEndometrial ablation (EA) is a minimally invasive treatment for heavy menstrual bleeding (HMB). Patient satisfaction rates for EA are around 80\u0026ndash;90%; however, about 10\u0026ndash;20% of women require additional surgery (re-ablation or hysterectomy) due to persistent bleeding or pain [1]. Women with adenomyosis are more likely to fail EA [2]. Those with unsatisfactory outcomes from EA may be offered hysterectomy as their only remaining treatment option. Case series and meta-analyses have demonstrated that UAE is effective in alleviating adenomyosis-related HMB and dysmenorrhea [3, 4]. However, the effectiveness of UAE in treating women who failed prior EA has not been previously reported. This is a retrospective cohort study of the outcome of UAE for adenomyosis in women who failed previous EA.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis study was approved by the institutional Human Research Ethics Committee. Informed consent was obtained from each participant. Women presenting to our clinic with significant dysmenorrhea and/or HMB following unsatisfactory endometrial ablation were offered UAE as an alternative to hysterectomy. Medical records of women who had UAE for adenomyosis at our institution between January 2017 and March 2022 were reviewed to identify those who had EA prior to UAE. All women had pre-UAE MRI to confirm the presence of adenomyosis, diagnosed based on previously published criteria: junctional zone thickness of \u0026ge;12mm or \u0026gt;40% of myometrial thickness, or the presence of T2 hyperintense cysts/foci/fissuring [5]. All UAE procedures were performed with polyvinyl alcohol (PVA) particles, with sizes starting at 150 or 250 microns, as previously described [3]. To evaluate the clinical outcome, a 2-part online survey was sent to women to complete. Part 1 inquired about symptoms, menopausal status, overall satisfaction, and requirement for further intervention (Appendix 1). Women who had heavy menstrual bleeding prior to UAE were asked about their periods at the time of the audit. Overall success rate of UAE was assessed by asking women if they were \u0026ldquo;Very Happy,\u0026rdquo; \u0026ldquo;Happy,\u0026rdquo; \u0026ldquo;Not sure,\u0026rdquo; \u0026ldquo;Not Happy,\u0026rdquo; or \u0026ldquo;Very Unhappy\u0026rdquo; about the outcome. Only women who rated \u0026ldquo;Very Happy\u0026rdquo; or \u0026ldquo;Happy\u0026rdquo; were regarded as overall successful. Part 2 consisted of the validated Uterine Fibroid Symptom and Quality of Life Survey (UFSQoL) [6]. The following parameters before UAE and at follow-up were recorded and compared: dysmenorrhea visual analogue scale (VAS) pain score, number of days with dysmenorrhea, symptom score, and QoL score (using UFSQoL). Uterine volume and junctional zone thickness at baseline MRI and 6 months follow-up were compared. Significance of changes before and after treatment was analyzed using T-tests.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBetween January 2017 and March 2022, UAE procedures were performed in 270 women for adenomyosis, some of whom also had fibroids. Eighteen women were identified with prior ablation failure (see Table 1): 15 with pure adenomyosis and 3 with coexisting fibroids. One woman was lost to follow-up; the outcomes of 17/18 (94.4%) were available for analysis, at a mean follow-up of 1.6 years post-UAE (median 2, range 0.6\u0026ndash;3 years). Significant reductions in pain score (VAS 6.29), number of days in pain (2.6 days), symptom score (32.1/100), and significant improvement in QoL (39/100) were noted (Table 2a). For the 8 women who still had HMB post-ablation, 7 (87.5%) saw significant improvement. Overall, 15/17 patients (88.2%) were \u0026ldquo;Happy\u0026rdquo; or \u0026ldquo;Very Happy\u0026rdquo; with the outcome of the UAE procedure (Chart 1). Only 1 (5.9%) woman required a hysterectomy. No other women required further intervention such as laparoscopy for residual pain/endometriosis. No immediate or long-term complications were noted in this audit. Thirteen women (76.5%) attended follow-up imaging (Figure 1). Significant uterine volume reduction and JZ thickness reduction were noted (Table 2a).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study has shown that UAE can be an effective treatment for post-ablation adenomyosis, with significant improvement in pain and residual HMB. Overall patient satisfaction is 88.2%, and 94.1% were able to avoid a hysterectomy. The results from this post-ablation failure cohort compare favourably with previously reported overall UAE outcomes for adenomyosis [3, 4]. The question of whether EA should be used to treat adenomyosis should be raised. Depth of involvement of adenomyosis has been shown to be associated with endometrial ablation failure [7]. Deep adenomyosis (\u0026gt;2.5 mm) is present in a significant number of women who underwent hysterectomy after failed endometrial ablation [8]. EA devices are designed to cause thermal destruction of 4-6 mm depth of tissue to the basalis level [9]. MRI diagnosis of adenomyosis requires junctional zone thickness of 12 mm or more [5]. Therefore, if the diagnosis of adenomyosis is established based on MRI criteria, there is a high chance that endometrial ablation might fail. We argue that if adenomyosis is established on imaging, UAE instead of EA should be offered to women as an alternative to hysterectomy. Previous studies suggest that ablation either activates surviving endometrial tissue to penetrate the myometrium, causing adenomyosis, or activates embedded ectopic endometrial glands to grow deeper into the myometrium, resulting in deeper adenomyosis [10]. This might explain dysmenorrhea as a main clinical feature of EA failure that requires further intervention. Women with dysmenorrhea might have endometriosis and/or adenomyosis and are therefore at risk of persistent pelvic pain after endometrial ablation, which treats neither of the two underlying conditions. The presence of pre-existing dysmenorrhea is the most strongly correlated risk factor for receiving a surgical reintervention such as hysterectomy [1]. Women\u0026rsquo;s health practitioners should be aware that failure to correctly diagnose adenomyosis might result in the inadvertent use of ablation, leading to further intervention. Improved diagnostic accuracy of adenomyosis may reduce the number of women undergoing inappropriate ablation. This might require wider use of MRI, which has a higher sensitivity and specificity than ultrasound in diagnosing adenomyosis [11]. This is a small retrospective cohort study. The average follow-up of 1.6 years remains short, and the longer-term hysterectomy rate is yet to be defined by future studies. It is not known if the adenomyosis was present prior to EA or developed subsequent to EA. There is no pathological proof of the underlying pathology being treated by UAE. Future studies could be designed to use MRI to document the absence of adenomyosis prior to EA and see if there is a reduction in EA failure rate.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eUAE is safe and effective in managing women who failed endometrial ablation, with significant improvement in dysmenorrhea and heavy menstrual bleeding. Most women were able to avoid hysterectomy following UAE for ablation failure.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e- \u0026nbsp;Ethical Approval and Consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants involved in the study.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Adventist HealthCare Limited Human Research Ethics Committee (HREC 2022-028)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- \u0026nbsp;Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe consent for publication in CVIR Endovascular\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003cstrong\u003e- \u0026nbsp;Availability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is available for review upon request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- \u0026nbsp;Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest identified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- \u0026nbsp;Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;There was no financial support from outside organisation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- \u0026nbsp;Authors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contribution are as follows:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEisen Liang\u0026rsquo;s role: design concept, ethics submission data collection, literature review, drafting of paper, submission.\u003c/p\u003e\n\u003cp\u003eRazeen Parvez\u0026rsquo;s role: data collection, data analysis, literature search, ethics submission\u003c/p\u003e\n\u003cp\u003eSylvia Ng\u0026rsquo;s role: data analysis, literature search, drafting / formatting/ referencing,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBevan Brown\u0026rsquo;s role: design concept, literature review, review of draft and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- \u0026nbsp;Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo special acknowledgements\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003cstrong\u003e- Authors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEisen Liang: Interventional Radiologist\u003c/p\u003e\n\u003cp\u003eRazeen Parvez: Research Assistant, Medical student\u003c/p\u003e\n\u003cp\u003eSylvia Ng: \u0026nbsp;Research Assistant, Radiology Trainee\u003c/p\u003e\n\u003cp\u003eBevan Brown: Gynaecologist\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBeelen, P. P., Reinders, W. I. M., Scheepers, C. F. W. M., Herman, J. M., Geomini, P. M. A., Van Kuijk, Y. M. C. M., \u0026amp; Bongers, M. Y. (2019). Prognostic Factors for the Failure of Endometrial Ablation: A Systematic Review and Meta-analysis. \u003cem\u003eObstetrics \u0026amp; Gynecology, 134\u003c/em\u003e(6), 1269-1281.\u003c/li\u003e\n\u003cli\u003eMengerink, B. B., van der Wurff, A. A. M., ter Haar, J. F., van Rooij, I. A., \u0026amp; Pijnenborg, J. M. A. (2015). Effect of Undiagnosed Deep Adenomyosis After Failed NovaSure Endometrial Ablation. \u003cem\u003eJournal of Minimally Invasive Gynecology, 22\u003c/em\u003e, 239\u0026ndash;244.\u003c/li\u003e\n\u003cli\u003ede Bruijn, A. M., Smink, M., Lohle, P. N. M., Huirne, J. A. F., Twisk, J. W. R., Wong, C., Schoonmade, L., \u0026amp; Hehenkamp, W. J. K. (2017). Uterine Artery Embolization for the Treatment of Adenomyosis: A Systematic Review and Meta-Analysis. \u003cem\u003eJournal of Vascular and Interventional Radiology, 28\u003c/em\u003e, 1629-1642.\u003c/li\u003e\n\u003cli\u003eLiang, E., Brown, B., \u0026amp; Rachinski, M. (2018). A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: Results in 117 women. \u003cem\u003eAustralian and New Zealand Journal of Obstetrics and Gynaecology, 58\u003c/em\u003e, 454-459.\u003c/li\u003e\n\u003cli\u003eAgostinho, L., Cruz, R., Os\u0026oacute;rio, F., Alves, J., Set\u0026uacute;bal, A., \u0026amp; Guerra, A. (2017). MRI for adenomyosis: a pictorial review. \u003cem\u003eInsights into Imaging\u003c/em\u003e. DOI: 10.1007/s13244-017-0576-z\u003c/li\u003e\n\u003cli\u003eSpies, J. B., Coyne, K., Guaou Guaou, N., et al. (2002). The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. \u003cem\u003eObstetrics and Gynecology, 99\u003c/em\u003e(2), 290-300.\u003c/li\u003e\n\u003cli\u003eMcCausland, A. M., \u0026amp; McCausland, V. M. (1996). Depth of endometrial penetration in adenomyosis helps determine outcome of rollerball ablation. \u003cem\u003eAmerican Journal of Obstetrics and Gynecology, 174\u003c/em\u003e, 1786\u0026ndash;1794.\u003c/li\u003e\n\u003cli\u003eMengerink, B. B., van der Wurff, A. A. M., ter Haar, J. F., van Rooij, I. A., \u0026amp; Pijnenborg, J. M. A. (2015). Effect of Undiagnosed Deep Adenomyosis After Failed NovaSure Endometrial Ablation. \u003cem\u003eJournal of Minimally Invasive Gynecology, 22\u003c/em\u003e, 239\u0026ndash;244.\u003c/li\u003e\n\u003cli\u003eDaub, C. A., Sepmeyer, J. A., Hathuc, V., Sakala, M. D., Caserta, M. P., Clingan, M. J., \u0026amp; Hosseinzadeh, K. (2015). Endometrial Ablation: Normal Imaging Appearance and Delayed Complications. \u003cem\u003eAmerican Journal of Roentgenology, 205\u003c/em\u003e(4).\u003c/li\u003e\n\u003cli\u003eMcCausland, A. M., \u0026amp; McCausland, V. M. (1996). Depth of endometrial penetration in adenomyosis helps determine outcome of rollerball ablation. \u003cem\u003eAmerican Journal of Obstetrics and Gynecology, 174\u003c/em\u003e, 1786\u0026ndash;1794.\u003c/li\u003e\n\u003cli\u003eChampaneria, R., Abedin, P., Daniels, J., Balogun, M., \u0026amp; Khan, K. S. (2010). Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. \u003cem\u003eActa Obstetricia et Gynecologica Scandinavica, 89\u003c/em\u003e(11), 1374-1384.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Baseline Parameters\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\" width=\"692\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eAge at time of procedure (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e42.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e42.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34\u0026ndash;53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eAge at time of UAE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e47.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40-54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eTime gap between Ablation and UAE (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0.4\u0026ndash;14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNo of patients with Residual HMB post ablation (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e8 (47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eVAS Pain score post ablation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0\u0026ndash;10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNumber of days in pain post ablation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0-10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMRI Uterine volume prior to UAE (cc)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e189.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e62\u0026ndash;427\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMRI JZ thickness prior to UAE (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e12\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2a: Results: changes against baseline\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"797\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.32663316582914%\" valign=\"top\"\u003e\n \u003cp\u003eReduction of mean VAS dysmenorrhea pain score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"59.67336683417086%\" valign=\"top\"\u003e\n \u003cp\u003e6.29, (P \u0026lt;0.0001)\u003c/p\u003e\n \u003cp\u003eFrom 8.1 (median 9, range 0\u0026ndash;10) to 1.9 (median 1, range 0\u0026ndash;5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.32663316582914%\" valign=\"top\"\u003e\n \u003cp\u003eReduction of number of days in dysmenorrhea\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"59.67336683417086%\" valign=\"top\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003cp\u003eFrom 2.7 (median 2, range 10) to 0.1 (median 0, range 2)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.32663316582914%\" valign=\"top\"\u003e\n \u003cp\u003eImprovement of mean UFS symptom score\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"59.67336683417086%\" valign=\"top\"\u003e\n \u003cp\u003e32.1, (P \u0026lt;0.0001)\u0026nbsp;\u003cbr\u003e\u0026nbsp;From 51.4 (median 53.13, range 25\u0026ndash;100) to 19.3 (median 12.5, range 0\u0026ndash;78.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.32663316582914%\" valign=\"top\"\u003e\n \u003cp\u003eImprovement of mean UFS QoL score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"59.67336683417086%\" valign=\"top\"\u003e\n \u003cp\u003e39.0, (P \u0026lt;0.0001)\u003c/p\u003e\n \u003cp\u003eFrom 46.0 (median 56.0, range 2.6\u0026ndash;80.2) to 84.9 (median 94.0, range 33.6\u0026ndash;100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.32663316582914%\" valign=\"top\"\u003e\n \u003cp\u003eImprovement in menorrhagia (n=8)\u003cbr\u003e\u0026nbsp;(BTN, LTN, LTE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"59.67336683417086%\" valign=\"top\"\u003e\n \u003cp\u003e7 (87.5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.32663316582914%\" valign=\"top\"\u003e\n \u003cp\u003eClinical success (Happy or Very Happy with outcome)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"59.67336683417086%\" valign=\"top\"\u003e\n \u003cp\u003e15/17 patients (88.2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.32663316582914%\" valign=\"top\"\u003e\n \u003cp\u003eMean Uterine volume reduction (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"59.67336683417086%\" valign=\"top\"\u003e\n \u003cp\u003e66.5(35.1%), (P \u0026lt;0.001)\u0026nbsp;\u003cbr\u003e\u0026nbsp;From 189.7 (median 178, range 62\u0026ndash;427) to 123.3 (median 90, range 36\u0026ndash;242)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.32663316582914%\" valign=\"top\"\u003e\n \u003cp\u003eMean JZ thickness reduction (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"59.67336683417086%\" valign=\"top\"\u003e\n \u003cp\u003e3.9 (P \u0026lt;0.003)\u003c/p\u003e\n \u003cp\u003eFrom 17.9 (median 16, range 6 -24) to 14 (median 11, range 8 to 27)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Chart 1","content":"\u003cp\u003eChart 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4268436/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4268436/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo report the effectiveness of uterine artery embolisation (UAE) in treating adenomyosis in women who failed prior endometrial ablation (EA).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e This is a retrospective cohort study. Medical records of women who had UAE for adenomyosis over a five-year period were reviewed to identify women who had failed prior endometrial ablation (EA). A 2-part electronic survey was sent to these women: Part 1 inquired about changes in menstrual heaviness, period pain, menopausal status, overall satisfaction, and requirement for further intervention. Part 2 consisted of the Uterine Fibroid Symptom and Quality of Life Survey (UFSQoL). Pain score, number of days in pain, MRI uterine volume, junctional zone thickness, and Symptom and QoL scores before and after UAE were compared.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Eighteen women who had undergone EA prior to UAE were identified. One was lost to follow-up, leaving 17 women available for review, with a mean follow-up of 1.6 years (range 0.6 to 3 years). The mean reduction in pain score was 6.29, the mean reduction in symptom score was 32.1, and the mean QoL improvement was 39, all significant (P\u0026lt;0.0001). Improvement in menorrhagia was reported in 7/8 (87.5%) women. Fifteen (88.2%) women were satisfied with the outcome. Only 1/17 (5.9%) women proceeded to hysterectomy. Mean uterine volume reduction was from 189.7 mL to 123.3 mL. Mean junctional zone reduction was from 17.9 mm to 14.0 mm. No complications were noted in this audit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eUAE is effective in managing adenomyosis in women who failed prior endometrial ablation, with significant improvement in dysmenorrhea and heavy menstrual bleeding.\u003c/p\u003e","manuscriptTitle":"Uterine Artery Embolisation for Adenomyosis in Women Who Failed Prior Endometrial Ablation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-17 14:39:20","doi":"10.21203/rs.3.rs-4268436/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2024-07-05T07:11:34+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-06-14T23:47:33+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-14T11:43:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-11T05:54:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"CVIR Endovascular","date":"2024-06-08T23:44:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"cvir-endovascular","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cire","sideBox":"Learn more about [CVIR Endovascular](https://www.springer.com/journal/42155)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/cire/default.aspx","title":"CVIR Endovascular","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e7e993e2-e047-49d4-8b5d-4a788edd09c4","owner":[],"postedDate":"July 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-01T17:07:38+00:00","versionOfRecord":{"articleIdentity":"rs-4268436","link":"https://doi.org/10.1186/s42155-024-00471-5","journal":{"identity":"cvir-endovascular","isVorOnly":false,"title":"CVIR Endovascular"},"publishedOn":"2024-07-27 16:16:10","publishedOnDateReadable":"July 27th, 2024"},"versionCreatedAt":"2024-07-17 14:39:20","video":"","vorDoi":"10.1186/s42155-024-00471-5","vorDoiUrl":"https://doi.org/10.1186/s42155-024-00471-5","workflowStages":[]},"version":"v1","identity":"rs-4268436","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4268436","identity":"rs-4268436","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}