January 8, 2024
For many years a hysterectomy was considered the only option for treating a variety of uterine conditions, including fibroids, endometriosis, and adenomyosis. The reasoning behind this consistent recommendation is that by removing the uterus entirely you remove the condition entirely.
While this is true, the costs of hysterectomy are high - removing the uterus means women give up the chance for future pregnancies, making it an unsuitable option for a large percentage of women.
However, for nearly 2 decades, a minimally invasive, uterus-preserving treatment option has been used to treat adenomyosis, with plenty of research suggesting it may be the most effective alternative to a hysterectomy.
In this article, we’ll look at Uterine Artery Embolisation (UAE) and the reasons why you should consider it to treat your adenomyosis.
What is Adenomyosis?
Adenomyosis is a condition where the lining of the womb extends abnormally deep into the uterus. The uterine tissue and cells grow deep in the muscular wall of the uterus and thickens it.
The displaced tissue will break down and bleed during a menstruation cycle, and this can cause discomfort and painful periods. It may also lead to abnormally heavy periods and bloating.
It is very similar to endometriosis, often presenting very similar symptoms. For this reason, the research linking yoga with pain relief from endometriosis is good news for those with adenomyosis - you can expect to get the same benefits.
Can Adenomyosis be Surgically Removed?
Adenomyosis is not well suited for surgical removal, since it is an infiltrative condition. The boundaries between healthy and non-healthy uterine tissue are not well defined, unlike fibroids which can be easily separated and surgically removed.
Because of this, surgery usually results in too little or too much adenomyotic tissue being removed, which can lead to regrowth in the former case, and unnecessary tissue removal in the latter.
An Alternative to Hysterectomy for Treating Adenomyosis
A hysterectomy was previously seen as the gold standard since it removes the uterus entirely and was thought of as the only ‘true’ way to cure adenomyosis.
It gets around the problem of identifying how much uterine tissue to remove but, of course, with a hysterectomy, women lose the opportunity for future childbirth.
However, since the early 2000s, there is growing evidence suggesting UAE is highly effective at treating adenomyosis.
What is Uterine Artery Embolisation?
Uterine artery embolisation (often referred to as uterine fibroid embolisation) is a minimally invasive treatment option for treating adenomyosis.
Performed by an interventional radiologist, blocking agents are inserted into the affected arteries that are supplying blood to the adenomyotic tissue, reducing blood flow and shrinking the tissue over time.
It is generally done under sedation and a local anaesthetic, although some women are awake during the procedure. This may make UAE a viable option for women who can’t have the general anaesthetic used for more invasive treatments.
How Is It Performed?
Following sedation, an interventional radiologist will insert a tiny catheter through the wrist or groin and manoeuvre it into the uterine artery under X-ray guidance. Tiny particles are then injected into the arteries supplying the affected tissue. The whole procedure takes about 90 minutes. No abdominal incisions or scars are made, and no stitches are needed.
After the procedure, you will need to remain in the hospital overnight. If you can eat and drink normally in the morning and your pain is controlled, you can go home.
What Are The Benefits?
As UAE is a non-surgical treatment option, it has a range of benefits that traditional management of adenomyosis does not provide:
- It’s safer than other alternatives – Current evidence and clinical study show that the risk of major complications is lower for UAE than other surgical fibroid treatment options.
- It’s effective – clinical studies have shown that UAE provides lasting relief from symptoms in over 80% of women.
- It doesn’t preclude other treatments (if required) – For those who remain symptomatic, surgical options remain possible after UAE.
- Its recovery period is shorter – since surgical incisions aren’t used and damage to the body’s tissues is minimised, recovery is usually much quicker compared to invasive surgery methods.
- Your uterine remains intact - while it is true that hysterectomy is the 'gold standard' for adenomyosis treatment, losing the ability to fall pregnant means it is not suitable for everyone. UAE treats adenomyosis and keeps your uterine intact.
What is Recovery Like?
Following the procedure, you'll need to stay in the hospital overnight, with most women being able to go home the following morning if their pain is under control.
The pain is usually the worst in the first 12 hours, and it's quite common for you to feel nauseous and have no appetite, although you are allowed to eat and drink. During this time you'll be provided with pain medication.
In the morning, you'll have your bladder catheter removed, be allowed to walk around and have a shower. You'll be provided with take-home medication including Panadol and nonsteroidal anti-inflammatory drugs.
Once home you'll need to take it easy for a few days and may feel tired and lethargic. After about 5 days you should feel well enough to venture outside, and after approximately 7 days you can return to work and regular activities.
Relieving Your Adenomyosis Symptoms
If you’ve been diagnosed with adenomyosis, or are suffering from pelvic pain that is unusually strong, it may be time to speak with a professional. At Northern Beaches Interventional Radiology, we are experts in minimally invasive treatment options for conditions such as adenomyosis. Book a consultation today and let us develop the perfect treatment plan for you.
