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.