Uterine Artery Embolization May Offer Relief to Women with Adenomyosis
By Alicia Armeli

Adenomyosis

A widely estimated 5 to 70 percent of women have adenomyosis (ad-uh-no-my-oh-sis)—a common gynecological condition that causes the lining of the uterus to grow into the uterine wall.1 Although the majority of women with this condition experience no symptoms at all, about one-third suffers from symptoms like heavy periods, pelvic pain, and urinary frequency.2

Given the nature of the disease, hysterectomy is currently considered the only definitive treatment for this condition. Because of this, researchers continue to search for an effective minimally invasive option to offer women, including uterine artery embolization (UAE).

“Although UAE is commonly known as a treatment for uterine fibroids, it can also be used to treat adenomyosis,” explains Dr. Richard Shlansky-Goldberg, MD, Interventional Radiologist and Professor of Radiology, Obstetrics and Gynecology, and Surgery at the Hospital of the University of Pennsylvania in Philadelphia. “Medical therapy is an option, as is hysterectomy—but not every woman wants hormones or surgery, which makes UAE a viable alternative.”

Whether it’s utilized to treat fibroids or adenomyosis, UAE’s technique remains the same. By injecting particles into the uterine arteries and blocking blood flow to the troublesome areas—like when embolizing fibroids—interventional radiologists can target the affected tissue, depriving it of oxygenated blood, causing it to die and symptoms to subside.

To test the effectiveness of the UAE procedure, Dr. M. D. Kim, MD, from Yonsei University College of Medicine in Seoul, Korea, and a team of researchers examined the outcomes of 50 women who underwent UAE for symptomatic adenomyosis.1 The team observed rates of affected tissue death and symptom recurrence 18 to 48 months following the procedure.

The results published in the Journal of Vascular and Interventional Radiology showed that symptoms returned in almost one-fourth of the patients treated. The researchers found that when less than 34 percent of the targeted uterine tissue was killed, symptoms were more likely to come back in comparison to cases where more tissue could be treated.

These results show that treating adenomyosis with UAE won’t offer the same results as when using it to treat fibroids. “The problem with adenomyosis is that it isn’t abnormal tissue growing—like we see with fibroids,” Dr. Shlansky-Goldberg emphasizes. “It’s normal tissue growing in an abnormal place, which can be more difficult to treat, especially if it fills the majority of the uterus.”

Long-term success rates following UAE for fibroid treatment average around 90 percent, whereas rates for complete symptom resolution after treatment of adenomyosis—although mixed—can run a little over 55 percent after only two years. 2,3

To improve UAE outcomes when treating adenomyosis, researchers are trying different methods in hopes of getting better results. A small study testing the “1-2-3 Protocol” of embolization—a technique that involves the use of small, normal and larger size particles during a single procedure—resulted in complete necrosis, or death of affected uterine tissue, in 80 percent of patients with no reported symptom recurrence after following up for 18 months.2

And yet, interventional radiologists are wary of procedures that use smaller than normal size particles due to the risk of more pain after the procedure, injury to the uterine wall, or wasting away of the uterine lining—which could result in infertility.2

With mixed success rates, some women may need to look for additional treatments in order to have long-term relief. This could mean a second round of UAE.

“If a woman still experiences symptoms immediately after a UAE procedure that has successfully blocked all sources of blood flow to the affected tissue, a second round probably won’t improve her condition,” Dr. Shlansky-Goldberg clarifies. “But if symptoms recur after a few years, it would make sense to take another look. Blood vessels have a way of making new pathways that could redirect blood to affected uterine tissue, causing symptoms to come back.”

Although more studies are needed to solidify its long-term efficacy, UAE is a short-term treatment option for women with adenomyosis. “When it comes to the traditional adenomyosis treatment options available, women are often stuck between a rock and a hard place, especially if they don’t want a hysterectomy,” Dr. Shlansky-Goldberg tells Ask4UFE. “UAE’s success rates may be lower, but it still can help to improve their symptoms.”

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community. She is a paid consultant of Merit.

ABOUT THE DOCTOR  Richard Shlansky-Goldberg, MD, is an interventional radiologist and professor of Radiology, Obstetrics and Gynecology, and Surgery at the Hospital of the University of Pennsylvania in Philadelphia. Recognized by Best Doctors in America, as Castle Connolly’s America’s Top Doctors, and showcased in Philadelphia Magazine’s Top Docs issue—Dr. Shlansky-Goldberg specializes in helping women with uterine fibroids find relief. Collaborating with the department of obstetrics and gynecology at the University of Pennsylvania allows him to ensure every woman knows and understands all her treatment options, ensuring the best patient care possible. 

REFERENCES

  1. Bae, S. H., Kim, M. D., Kim, G. M., Lee, S. J., Park, S. I., Won, J. Y., & Lee do, Y. (2015). Uterine artery embolization for adenomyosis: percentage of necrosis predicts midterm clinical recurrence. Journal of Vascular and Interventional Radiology, 26(9): 1290-1296. doi: 10.1016/j.jvir.2015.04.026
  2. Kim, M. D., Kim, Y. M., Kim, H. C., Cho, J. H., Kang, H. G., Lee, C., Kim, H. J., & Lee, J. T. (2011). Uterine artery embolization for symptomatic adenomyosis: a new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes. Journal of Vascular and Interventional Radiology, 22(4): 497-502. doi: 10.1016/j.jvir.2011.01.426
  3. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.