Adenomyosis is a common gynecological condition. Uterine Artery Embolization (UAE) offers a non-surgical approach to manage adenomyosis symptoms. This article explores UAE as a treatment, detailing its mechanism, procedure, recovery, and outcomes.
Understanding Adenomyosis
Adenomyosis describes a condition where endometrial tissue, which normally lines the uterus, grows into the muscular wall (myometrium). This misplaced tissue thickens and bleeds during the menstrual cycle, causing the uterus to become enlarged and thickened.
Individuals with adenomyosis commonly experience heavy menstrual bleeding (menorrhagia) and severe menstrual cramps (dysmenorrhea). Chronic pelvic pain, which can persist outside of menstruation, and pain during sexual intercourse are also frequent. The uterus may feel tender or enlarged, and some individuals notice abdominal bloating.
Diagnosing adenomyosis typically involves imaging. Transvaginal ultrasound is a common initial diagnostic tool. If ultrasound results are unclear or more detailed imaging is needed, a Magnetic Resonance Imaging (MRI) scan may be performed to confirm the diagnosis and assess the condition’s extent.
Uterine Artery Embolization Explained
Uterine Artery Embolization is a minimally invasive procedure performed by an interventional radiologist. The procedure works by selectively blocking the blood flow to the affected areas of the uterus.
During the procedure, tiny particles, called embolic agents, are injected into the uterine arteries. These arteries are the primary blood vessels supplying the uterus. The particles travel through the bloodstream, lodging in smaller vessels that nourish the adenomyotic tissue.
By obstructing these blood vessels, the embolic agents cut off the blood supply to the misplaced endometrial tissue within the myometrium. This deprivation of oxygen and nutrients leads to the gradual shrinkage and necrosis of the abnormal tissue. Healthy uterine tissue, which receives blood supply from other sources, is generally preserved, allowing the uterus to remain intact while symptoms diminish.
The UAE Procedure and Recovery
The UAE procedure is typically conducted with the patient under local anesthesia and mild sedation. A small puncture is made in an artery, usually in the groin (femoral artery) or sometimes the wrist (radial artery). A thin, flexible tube called a catheter is then inserted into this artery.
Using real-time X-ray imaging (fluoroscopy), the interventional radiologist guides the catheter through blood vessels to the uterine arteries. Embolic particles are then injected. The procedure typically takes 30 minutes to an hour.
Following the procedure, patients commonly remain in the hospital for overnight observation, though some may return home on the same day. It is common to experience pelvic pain and cramping for a few days, managed with medication. Some individuals may also experience nausea and fatigue during the initial recovery period.
Most patients can resume their normal daily activities within one to two weeks after the procedure. Strenuous physical activities should be avoided for approximately 14 days. Patients might notice a small to moderate amount of vaginal discharge for several days post-procedure. It is also advised to refrain from using douches or tampons and avoid sexual intercourse for about two weeks.
Outcomes and Considerations
Uterine Artery Embolization for adenomyosis often leads to significant symptom improvement. Studies indicate that around 83.1% of patients report symptom improvement, particularly in heavy menstrual bleeding and pelvic pain. Long-term studies demonstrate the durability of UAE, with an estimated cumulative success rate of 80% at a mean follow-up of 52 months.
Symptom improvement is often gradual, with changes becoming noticeable over several weeks to a few months, typically within three to six months following the procedure.
Potential considerations and side effects exist with UAE. Some individuals may experience post-embolization syndrome, characterized by symptoms like fever, pain, and nausea, which usually resolve within a few days. Less common risks include bleeding or bruising at the catheter insertion site, or rarely, injury to the artery. There is also a small risk of an allergic reaction to the contrast dye used during the imaging.
UAE is a suitable option for individuals who wish to avoid a hysterectomy. It is also considered for those whose adenomyosis symptoms are not adequately controlled by medications or hormonal therapies, and for individuals who desire to preserve their fertility. A thorough discussion with a healthcare provider is important to determine if UAE aligns with an individual’s specific health needs and goals.