Is this you?

The information on this page may be relevant if any of the following describe your situation:

• Painful periods that disrupt your daily routine or work.

• Heavy periods, sometimes with clots, that affect how you plan your month.

• A persistent or worsening dragging or pressure sensation in the pelvis.

• Pain during intercourse.

• You are considering your options after being told you may have adenomyosis, or following imaging showing an enlarged or “bulky” uterus.

• You would like to explore uterus-preserving treatment options alongside medical and surgical approaches.

What is adenomyosis?

Adenomyosis is a condition in which tissue similar to the lining of the womb (the endometrium) is found within the muscular wall of the uterus (the myometrium).

It commonly causes painful periods, heavy menstrual bleeding, pelvic pressure, or a sensation of fullness, and can significantly affect quality of life.

Adenomyosis is often diagnosed on pelvic ultrasound or MRI and may occur on its own or alongside fibroids.

Who may be suitable?

Treatment for symptomatic adenomyosis is usually led by the gynaecology team and tailored to the symptoms that are having the greatest impact — such as heavy bleeding, pain, or fertility concerns.

Medical therapy is typically considered first and may include:

• Non-steroidal anti-inflammatory medication (NSAIDs)

• Tranexamic acid

• Hormonal treatments such as:

  • Intrauterine systems (IUS)

  • Combined oral contraceptives

  • Oral progestins

  • Gonadotropin-releasing hormone analogues

The evidence base for medical management continues to evolve, and no single treatment is considered universally first-line.[1]

Where medical therapy is not tolerated, is no longer effective, or is unsuitable, the gynaecology team may discuss additional options, including:

• Uterus-preserving surgery (such as adenomyomectomy)

• Hysterectomy

• Uterine artery embolisation (UAE)

NICE has reviewed UAE as a treatment option for adenomyosis (Interventional Procedures Guidance IPG473) and concluded that the available evidence is limited in quantity. NICE advises that the procedure should only be performed with appropriate arrangements for clinical governance, consent, and audit, and recommends that patient selection should involve a multidisciplinary team including both a gynaecologist and an interventional radiologist.[2]

A more recent peer-reviewed meta-analysis by Liu and colleagues (2023), reviewing 5,877 patients undergoing uterus-preserving treatments for adenomyosis, reported that UAE can provide meaningful symptom improvement for many women. The study also noted higher rates of symptom recurrence and reintervention compared with uterus-preserving surgery, while highlighting that patients selected for UAE often have larger uteri and more extensive disease. The authors concluded that further high-quality randomised studies are needed.[3]

Where UAE is performed for adenomyosis at Hertfordshire Private Healthcare at Lister Hospital, it is carried out in accordance with hospital policy and the NICE IPG473 framework, including an individual consent discussion.

The realistic chance of benefit, the possibility of recurrence, and the available alternatives are discussed carefully before any treatment decision is made.

A multidisciplinary decision

At Pinhole Clinic™, the decision about whether UAE for adenomyosis is an appropriate treatment option is made jointly between Dr El Farargy and the gynaecology team involved in your care.

Interventional radiology is a recognised consultant-led subspecialty within Clinical Radiology, with dedicated training, examinations, and standards of practice.

The multidisciplinary discussion brings together complementary expertise, including imaging interpretation, procedural feasibility and risk, and the wider clinical context. Findings and recommendations are shared with the referring team so that any treatment plan agreed is supported by the patient, the interventional radiologist, and the gynaecology team.

Suitability is assessed using clinical history and detailed imaging — usually pelvic MRI — and discussions include the realistic likelihood of symptom improvement, the possibility of recurrence, and the available alternatives.

What the procedure involves

Before the procedure, an up-to-date pelvic MRI is usually required to confirm the diagnosis and assess the extent of adenomyosis. Where needed, this can be arranged through Pinhole Clinic™.

UAE is usually performed under local anaesthetic, sometimes with light sedation, through a small puncture in the wrist or groin.

An overnight hospital stay is typically recommended for pain management and observation.

The procedure itself is similar to UAE performed for fibroids. A fine catheter is guided under X-ray imaging to the uterine arteries, and tiny particles are released to reduce blood flow to the affected tissue.

Recovery and follow-up

Pelvic cramping during the first 24–48 hours is common and is usually managed with prescribed pain relief.

Most women return to light activity within around one week and resume normal activities within approximately two weeks, although recovery times vary between individuals.

Improvement in pain and bleeding symptoms is usually gradual over the months following treatment. Follow-up is arranged so that response to treatment can be reviewed and future management planned together with the gynaecology team.

Risks and what we discuss at consultation

As with any medical procedure, UAE for adenomyosis carries potential risks and complications.

The most common is post-embolisation syndrome, which may include cramping, nausea, and a low-grade fever in the days following treatment. This is a recognised part of recovery and is usually managed with prescribed medication.

Less commonly, risks can include:

• Infection

• Non-target embolisation affecting nearby tissue

UAE may also affect ovarian function, with a small risk of earlier menopause. This is generally more relevant for women approaching menopausal age.

Current published evidence suggests higher rates of symptom recurrence and reintervention following UAE for adenomyosis compared with some surgical alternatives. Some women may find that symptoms do not improve sufficiently and may require further treatment in the future, including medical therapy, surgery, or repeat embolisation.

Outcomes vary between individuals depending on the extent of disease, uterine size, and other clinical factors.

The risks, benefits, and alternatives relevant to your situation are discussed in detail during consultation.

How to be assessed

Pinhole Clinic™ accepts referrals from gynaecologists, GPs, and other healthcare professionals. Patients are also welcome to request a consultation directly.

Because decisions regarding uterine artery embolisation for adenomyosis depend on diagnosis, imaging findings, symptoms, and the wider clinical picture, assessment is made jointly between Dr El Farargy and the relevant specialty team.

If you have not yet been assessed by a specialist in the appropriate field, we can help arrange this as part of the multidisciplinary pathway. This may be required for clinical assessment and, where applicable, for insurance authorisation.

Whether you contact the clinic directly or are referred by another healthcare professional, the aim is the same: to determine together whether a minimally invasive treatment approach is appropriate for you.

References

1. Etrusco A, et al. Current Medical Therapy for Adenomyosis: From Bench to Bedside. Drugs. 2023;83(17):1595–1611.
   https://pubmed.ncbi.nlm.nih.gov/37837497/

2. NICE. Interventional Procedures Guidance IPG473 — Uterine artery embolisation for treating adenomyosis.
   https://www.nice.org.uk/guidance/ipg473

3. Liu L, et al. Risk of Recurrence and Reintervention After Uterine-Sparing Interventions for Symptomatic Adenomyosis. Obstetrics and Gynecology. 2023.
   https://pubmed.ncbi.nlm.nih.gov/36897132/