Medical care first
Often the initial approach. The exact plan depends on symptoms, pregnancy goals, other health factors and response to treatment.
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Uterine health · patient guide
Adenomyosis: when medical treatment has not helped
If adenomyosis symptoms continue despite conservative treatment and hysterectomy has been discussed, uterine artery embolisation (UAE) may be an option to ask a gynaecologist and interventional radiologist about. It is not first-line care, is not suitable for everyone, and cannot guarantee that hysterectomy will be avoided.
See when UAE may be discussed ↓Important: UAE is one possible uterus-preserving option for selected people after medical management has failed, is not tolerated, or is unsuitable. The treatment decision should be shared with the gynaecology and interventional radiology teams.
First stepsAssessment and conservative treatment are usually considered first
When UAE may enter the discussionPersistent symptoms when medical care has not helped and surgery is being considered
Important to knowRelief varies; symptoms can return and further treatment may be needed
What is adenomyosis?
Endometrial-type tissue within the uterine muscle
Adenomyosis is a benign condition in which tissue resembling the lining of the uterus is found within its muscular wall. The muscle can become thickened and the uterus may enlarge. It may be diffuse, affecting a broader area, or focal, forming a localized area sometimes called an adenomyoma. Adenomyosis is different from fibroids, although both can occur together.
Some people have no symptoms. Others may experience heavy or prolonged menstrual bleeding, painful periods, pelvic pain or pressure. These symptoms can have other causes too, so assessment matters.
Symptoms and diagnosis
How is it assessed?
Assessment usually includes a review of bleeding and pain, medical history, examination as appropriate, and pelvic imaging. Transvaginal ultrasound is commonly used; MRI may help clarify the pattern, extent, or other pelvic conditions. Imaging findings should be interpreted with symptoms and clinical context, because no single scan measurement answers every question.
Your team may also evaluate other reasons for bleeding or pain, including fibroids, endometriosis, endometrial problems or infection, when relevant.
Where embolisation fits
UAE is not a first-line treatment for adenomyosis.
Medical options are commonly considered first and chosen around symptoms, health history and preferences. These may include pain-relieving medicines, medicines to reduce bleeding, hormonal treatments such as a levonorgestrel intrauterine system or progestins, and other clinician-directed options. A gynaecologist can explain what is appropriate and the likely benefits and trade-offs.
Why this page focuses on UAE: If symptoms remain difficult despite conservative medical management—or those treatments are unsuitable or not tolerated—and hysterectomy has been advised or is under discussion, some patients may wish to ask whether UAE could be considered before proceeding. UAE aims to reduce blood supply to the uterus and is a less invasive, uterus-preserving procedure. It is not a guaranteed substitute for hysterectomy and may not provide lasting relief.
UAE: a selected alternative
May be discussed after medical care has not helped, is unsuitable, or is not tolerated—particularly when hysterectomy is being considered and the patient wants to explore a uterine-preserving option.
Hysterectomy: definitive uterine treatment
Removing the uterus ends uterine adenomyosis, but it is major surgery and permanently ends the ability to carry a pregnancy. The surgical and recovery considerations should be discussed with the gynaecologist.
Shared decision-making
Who might ask about UAE?
A discussion may be reasonable for a person with troublesome symptoms and imaging consistent with adenomyosis, when conservative treatment has not provided enough relief, and when hysterectomy is being considered but the person wants to understand uterus-preserving options. The gynaecologist and interventional radiologist should review the case together where possible.
Whether UAE is appropriate depends on the diagnosis, pattern of disease, symptoms, other pelvic conditions, overall health and personal priorities. A specialist may advise against it or recommend another option.
If future pregnancy matters to you: say so before choosing treatment. Pregnancy and fertility outcomes after UAE for adenomyosis remain uncertain. UAE should not be presented as a fertility treatment, and it may affect ovarian or uterine function. Ask for an individualized discussion with your gynaecologist and, if relevant, a fertility specialist.
How UAE works
A catheter guides treatment through the uterine arteries
The interventional radiologist uses X-ray imaging to guide a fine catheter from an artery in the wrist or groin to the uterine arteries. Small particles are delivered to reduce blood flow to the uterine tissue affected by adenomyosis. The access point is small; the procedure still requires careful planning, pain control, monitoring and follow-up.
Review
The team reviews symptoms, prior treatment, ultrasound/MRI, goals, medicines and relevant tests.
Plan and consent
You discuss expected benefits, limitations, alternatives, risks, pain-control and the possibility of later surgery.
Image-guided treatment
A catheter is guided under X-ray and particles are delivered through the uterine arteries, if the procedure proceeds.
Recovery and follow-up
The team treats post-procedure pain, checks recovery and arranges review of symptoms and imaging when appropriate.
Evidence in context
What does the research tell us?
Published studies report that some patients experience less bleeding and pain after UAE, but much of the evidence comes from observational cohorts with different patient groups and follow-up periods. Symptoms may recur, and some people later need another procedure, including hysterectomy.
The 2025 QUESTA prospective comparison found quality of life improved after both UAE and hysterectomy at one year. It could not establish that UAE was non-inferior to hysterectomy, and more participants reported satisfaction after hysterectomy. This supports a balanced discussion, not a promise that UAE is equivalent or better.
Research is continuing. Results from one study cannot predict an individual patient’s outcome.
Risks and recovery
Plan for recovery and know the trade-offs
Cramping or pelvic pain is common after embolisation; nausea, tiredness, a short-lived temperature or vaginal discharge may also occur. The clinical team should provide an individualized pain-control plan and clear instructions about follow-up.
Potential complications include infection, unintended injury to blood supply beyond the target, access-site problems, early menopause or changes in ovarian function, persistent or recurrent symptoms, and the need for additional treatment or hysterectomy. Serious complications are uncommon but possible. Ask the treating team about the risks that apply to you.
UAE is not a “one-and-done” guarantee. Hysterectomy remains a possible next step if symptoms persist or return.
Questions for your appointment
Questions worth asking
- How certain is the diagnosis, and could another condition explain my symptoms?
- What conservative treatments have I tried, and what else could reasonably be considered?
- Why is hysterectomy being advised in my case? What are its benefits, risks and alternatives?
- Could UAE be appropriate for my pattern of adenomyosis and medical history?
- What is known—and not known—about recurrence, later hysterectomy and future pregnancy?
- How are pain, complications and follow-up managed at this centre?
Illustration note: Images on this page are AI-generated educational illustrations. They are not actual scans, angiograms, patient photographs, or a substitute for clinical advice.
Evidence and further reading
Uterine artery embolization for adenomyosis: selected literature
This list prioritizes studies of UAE for adenomyosis, newest first. The 2026 evidence review found mostly observational studies with varied definitions and follow-up; the findings cannot predict an individual outcome. This page summarizes the evidence in original plain language.
- Pregnancy outcomes after UAE for adenomyosis: systematic review and meta-analysis (2026) — reproductive outcomes; evidence is limited and needs individualized specialist counselling.
- Systematic review and meta-analysis of UAE for symptomatic adenomyosis (2026) — 22 cohort studies and 1,701 patients; substantial heterogeneity and no randomized evidence in the included pool.
- Wei et al. Long-term outcomes of UAE in 666 patients with adenomyosis (Scientific Reports, 2025) — large retrospective cohort; associations do not establish comparative effectiveness.
- QUESTA study: quality of life after UAE compared with hysterectomy (2025) — prospective comparison; it did not establish non-inferiority of UAE.
- Yuan et al. Long-term follow-up after UAE for adenomyosis (2021) — follow-up cohort reporting symptom and imaging outcomes.
- Ma et al. Durability of UAE after initial clinical success in adenomyosis (2021) — longer-term outcomes and recurrence considerations.
- Liang et al. Clinical audit of UAE in 117 women with symptomatic adenomyosis (2018) — real-world cohort outcomes.
- de Bruijn et al. UAE for adenomyosis: systematic review and meta-analysis (JVIR, 2017) — pooled outcomes from earlier observational studies.
- Zhou et al. UAE for symptomatic adenomyosis: 252-patient clinical series (2016) — observational outcomes.
- Wang et al. UAE for adenomyosis: clinical follow-up cohort (2016) — symptom response and follow-up findings.
- Smeets et al. Long-term clinical follow-up after UAE for adenomyosis (2012) — durability and later-treatment outcomes.
Studies are provided for discussion with a gynaecologist and interventional radiologist. UAE is generally considered after discussion of established medical and surgical options; fertility goals require individualized counselling.
Want to discuss an assessment?
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