The Advantages and Disadvantages of Uterine Artery Embolization in Women with Adenomyosis: What’s New?

Purpose of Review This review will examine the use of uterine artery embolization (UAE) for the management of adenomyosis (AUB-A) and evaluate its advantages and disadvantages. Recent Findings In the last 5 years, 8 articles have described UAE for the management of AUB-A. These include 2 prospective and 5 retrospective studies and 1 systematic review and meta-analysis. There are no randomised controlled trials for UAE as a treatment of adenomyosis. Recent data report a reduction in heavy menstrual bleeding (HMB) in 80–88% of patients and a reduction in dysmenorrhoea in 76–80% of those undergoing UAE. Quality of life is reported to be significantly improved and uterine volumes reduced following treatment. Disadvantages of UAE include post-procedural pain, adenomyoma extrusion, pyomyoma, Asherman syndrome, and requirement for further intervention including subsequent hysterectomy for management of pain or bleeding. Summary Initial non-randomised data support uterine artery embolization as an effective modality for the conservative management of AUB-A. The advantages of UAE include avoidance of abdominal surgery, significant improvement in symptoms, and quality of life scores and preservation of reproductive potential. To date, most data are retrospective with no randomised controlled studies and a few prospective analyses. Randomised controlled data are needed to comprehensively evaluate UAE as conservative treatment for AUB-A and to compare efficacy, cost, and durability of both medical and surgical treatments.