There has been increasing interest in offering uterine artery embolization as a treatment option to women who have adenomyosis who are desirous of preserving their fertility, or those absolutely desiring uterine preservation. A study published in the June edition of CardioVascular and Interventional Radiology (CVIR) shows that uterine fibroid embolization resulted in long-term preservation of the uterus in the majority of cases of women with therapy-resistant adenomyosis studied in the cohort.
Additionally, the study concludes that most patients with preserved uterus were asymptomatic.
Author Albert J Smeets, Department of Radiology, St Elisabeth Ziekenhuis, Tilburg, The Netherlands, and colleagues write that the only predictor for hysterectomy during follow-up was initial thickness of the junction zone. “The presence or absence of fibroids in addition to adenomyosis had no relation with the need for hysterectomy or clinical outcome,” they write.
The long-term results of uterine artery embolization for adenomyosis are largely unknown and the study was designed to evaluate the long-term outcome of embolization in 40 women with adenomyosis.
Investigators treated 40 consecutive women who had adenomyosis (22 in combination with fibroids) between March 1999 and October 2006 with uterine artery embolization. They assessed the changes in the junction zone thickness with magnetic resonance imaging (MRI) at baseline and again at three months. The patients also filled out the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire, which had additional questions on the long-term evolution of baseline symptoms and adverse events after a mean clinical follow-up of 65 months.
In the follow-up period, 18% of the cohort (seven) underwent hysterectomy. Authors write that the junction zones of these seven women were significantly thicker, both at baseline (mean 23 vs. 16mm, p= 0.028) and at three-month follow-up (mean 15 vs. 9mm, p= 0.034).
Importantly, of the 82% (33) women who preserved the uterus, 29 were asymptomatic. Four patients had symptom severity scores of 50 to 85 and overall quality of life scores of 60 to 66, indicating substantial clinical symptoms. There was no correlation between clinical outcome and the initial presence of fibroids in addition to adenomyosis, the authors write.