Role of uterine artery embolisation in the management of uterine fibroids and adenomyosis

Can I treat my adenomyosis and fibroids without a hysterectomy?

Adenomyosis and fibroids are painful and distressing conditions that can cause heavy, painful periods, pain during intercourse and problems with fertility. The definitive treatment for both adenomyosis and fibroids is a hysterectomy to remove your womb. However, uterine artery embolisation can effectively treat adenomyosis and shrink fibroids and allow you to keep your uterus.

What is uterine artery embolisation?

Uterine artery embolisation or UAE is an innovative minimally invasive procedure in which part of the blood supply to the womb is blocked. The highly-targeted procedure blocks the blood vessel that carries blood to the fibroid or the area of adenomyosis. Uterine artery embolisation is a safe, effective alternative to surgery if medications haven’t controlled your symptoms and you wish to preserve your womb.

Under local anaesthetic, a specialist interventional radiologist introduces a fine tube into the womb via a blood vessel in your leg. They use X-ray guidance to precisely target the area, then inject tiny plastic or gelatin particles to block the blood vessel feeding the fibroid or adenomyosis. Without a blood supply, the fibroids or adenomyotic lesions progressively shrink, relieving the difficult and distressing symptoms.

What are fibroids?

Fibroids are non-cancerous growths made up of muscle and fibrous tissue. They are also known as leiomyomas or myomas and grow inside the womb. Fibroids can vary hugely in size. Some measure just a centimetre or so, while others can become enormous, taking over the whole abdomen.

Most women with fibroids suffer no problems. But as many as one in three women may suffer from pain and other issues from their fibroids. The bigger your fibroid, the more symptoms you may experience. The symptoms are caused by the fibroid pressing on other structures in the pelvis and the bigger surface area of the inside of the womb. You may notice heavy periods with clots and cramps, aching abdominal pain, the need to wee more frequently, constipation and deep pain during sexual intercourse. Sometimes fibroids can cause fertility problems and interfere with pregnancy, particularly if they are bigger or grow inside the womb.

Uterine artery embolisation and fibroids

Uterine artery embolisation can shrink fibroids and relieve your symptoms for as much as five years. UAE is an effective alternative to invasive surgery to remove the fibroid on your womb. However, over time the problems may return. In research, one in three women needed a further procedure to control their fibroids. The full impact of uterine artery embolisation on your future fertility is not fully understood, so it’s essential to discuss your treatment options and any pregnancy plans with your gynaecologist.

What is adenomyosis?

Adenomyosis is a painful and often misunderstood condition. The glandular lining that should be on the inside of the womb becomes embedded in the muscle of the uterus walls. This tissue bleeds during your monthly period, leading to inflammation, severe pelvic pain, and often heavy bleeding.

Adenomyosis is different from endometriosis, although both conditions cause
painful periods and painful sex. In endometriosis, the patches of endometrial lining are found outside the womb, and in adenomyosis, they are within the uterus walls. It used to be known as ‘inside-out endometriosis’, which is a helpful way of understanding the difference between the two diseases.

Uterine artery embolisation and adenomyosis

If pain relief and hormonal treatments haven’t controlled your adenomyosis symptoms, uterine artery embolisation can help ease your pain without losing your uterus.

Research shows that uterine artery embolisation is a durable, definitive treatment for adenomyosis. After UAE, eight out of ten women had fewer debilitating symptoms more than four years after treatment. UAE didn’t bring forward the menopause, but its effects on future fertility are not fully understood.

If conservative management with medicines or hormones hasn’t helped your adenomyosis, uterine artery embolisation is a less invasive alternative to hysterectomy.2