Since a large majority of patients with adenomyosis are completely asymptomatic. The diagnosis is usually confirmed using ultrasound or less commonly MRI. In general, MRI is better than ultrasound in determining the exact size and location of the adenomyosis. It also provides information concerning the blood supply to the adenomyosis that ultrasound cannot provides.

In some women, adenomyosis is “silent” , causing no signs or symptoms , or only mildly uncomfortable. But other women with adenomyosis may experience: –

Reproductive dysfunction- including infertility, recurrent miscarriages, premature labor, and complications of labor.

Till now the only most effective treatment for adenomyosis was Hysterectomy. i,e  removal of uterus. No other treatment gave permanent results. But now, the latest non-surgical treatment called uterine artery embolization is the most effective and curative treatment.

Various treatments can include:

• Hormone treatments including birth control pills, progestins (oral, injection or IUD) or GnRH-analogs such as Lupron- they give short term relief and symptoms commonly relapses.
• Endometrial ablation
• Hysterectomy
• Uterine artery embolization

Hysterectomy, It is an extensive surgery causing removal of uterus. Not advised in women who wants to retain their uterus. Also, post hysterectomy vague discomforts does not give the feeling of complete well being to the patient. It is an option for women not planning future pregnancies.
Uterine Artery Embolization (Non-surgical treatment option), It is now a well-established alternative to surgical therapy. Using imaging guided angiographic techniques, an Interventional Radiologist blocks (embolizes) the blood supply to the adenomyosis which causing the symptoms to resolve. This treatment preserves the uterus and potential fertility. It need just 24 hrs hospitalization, no need to remove the uterus and recovery is very short like 1-3 days.
MR Guided Focused Ultrasound, A non-invasive, outpatient procedure that uses high doses of focused ultrasound waves to destroy uterine adenomyosis, the adenomyosis located in posterior and inferior aspect of uterus which may not possible to treat but the uterine artery embolization option can treat easily.

UAE is also indicated for Single / multiple Uterine Fibroids, Failed myomectomy / recurrence of fibroids after myomectomy, High risk patient for surgery like obesity, anemia, Chronic renal failure etc, Post-partum Hemorrhage, Bleeding from Cancer of Cervix & Uterus, Pre-operative embolization to reduce bleeding during uterine surgery

Uterine artery embolization has been performed safely in thousands and thousands of women worldwide. While no procedure is without risk, adenomyosis embolization has been shown to have a lower complication rate than traditional surgical treatment options such as myomectomy. The few like failure rate, infections are extremely uncommon and can usually be treated with oral or IV antibiotics. Ovarian failure leading to premature menopause is also relatively uncommon occurring in 1 percent of patients who are nearing menopause.

The risk factors are

• History of prior uterine surgery, such as a C-section or fibroid removal
• Childbirth
• Infection
• Abortion

After UAE , the adenomyosis shrink and normal uterus and uterine tissue lives.

The overall successes rate of uterine artery embolization for adenomyosis is about 95%.

Most of the major insurance companies are now covering uterine artery embolization. Depending on your plan, specific referrals or other preauthorization may be necessary. Our clinical coordinator will assist you thru the approval process.

The uterine artery embolization procedure itself is painless. The procedure done under mild sedation. For the pain reason, we keep patients overnight in the hospital for pain control. The morning after the procedure, the symptoms have usually improved to a point where they can be easily controlled with oral medications provided for the patient at the time of discharge to take home.

The average recovery time before patients return to work or their normal daily activities is approximately one to three days.

After the procedure, we ask you to return to our office for routine follow-up in seven to 10 days. We also ask that you schedule an appointment to see your in two to three months after the procedure for a routine exam. We will plan for follow-up MRI in six to nine months to assess the results of embolization and to insure that the blood supply to the fibroids is eliminated.

While it varies from hospital to hospital, in general, uterine artery embolization is less expensive to hysterectomy and myomectomy. It is reported to be less expensive due to the shorter hospital stay and no need for general anesthesia.

Heavy menstrual bleeding (menorrhagia) and sever pain is controlled in 95% of patients after their procedure. Pressure related symptoms such as pelvic pain, pelvic pressure, frequent urination, constipation, back pain and painful intercourse are controlled in 95 percent of patients undergoing UAE.