Uterine Artery Embolization Improves Quality of Life in Patients with Pure Adenomyosis: A Single‑Center Experience

Abstract

Aim: The aim of the study was to assess clinical outcomes following uterine artery embolization (UAE) in the treatment of dysmenorrhea and menorrhagia related to pure adenomyosis. Materials and Methods: This was a retrospective analysis of 14 patients with dysmenorrhea and menorrhagia related to pure adenomyosis treated with UAE using polyvinyl alcohol (PVA) between January 2017 and September 2019. The baseline and 3-month and 12-month postintervention outcomes were assessed using Uterine Fibroid Symptom-Health-Related Quality of Life Questionnaire (UFS-QOL), Symptom Severity Score (SSS), and magnetic resonance imaging findings. The median age of the patients was 47 years (28–55). The main clinical presentation was dysmenorrhea and menorrhagia, with a median duration of symptom of 24 (12–84) months. All patients received combined estrogen-progestin and nonsteroidal anti-inflammatory drugs prior to UAE without clinical improvement. Results: According to UFS-QOL and SSS results, the score for distress level was statistically significantly reduced from baseline 4.6 (3.6–5) to 2.25 (1–3.37) (P = 0. 018) after 3 months, and remained stable 12 months later. The score of symptom level was statistically significantly reduced from 4 (3.6–5) at baseline to 1.6 (1–3.58) (P = 0. 018) after 3 months with maintained clinical satisfaction after 12-month follow-up. The junctional zone was statistically significantly reduced from baseline with a median of 33.5 mm (19–79 mm) to 25 mm (8–77 mm) after 3 and 12 months (P = 0.046). The incidence of post-UAE permanent amenorrhea is 71% with a mean age of 49 years. No patient underwent hysterectomy during the follow-up period. Conclusion: UAE using PVA can improve the quality of life in patients with menorrhagia and dysmenorrhea related to adenomyosis. However, larger prospective studies are needed to establish the long-term outcomes and risk of amenorrhea.