Adenomyosis

UAE is the probably the most effective uterine-preserving treatment. Sydney Fibroid Clinic’s own patient satisfaction rate is 90% – meaning 90% of women treated were happy or very happy with the outcome of their UAE in relieving heavy menstrual bleeding and period pain. Only 5% of treated women have gone on to have a hysterectomy. In other words, 95% of women treated were able to avoid a hysterectomy. Our paper can be viewed at the Doctors’ Resources section.

The treatment result seems to be durable and the 5-year symptom recurrence rate is around 11%.

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Uterine artery embolisation is performed by an interventional radiologist. During the procedure, tiny particles are injected inside the uterine arteries to block the blood flow, thereby starving the adenomyosis tissue, causing shrinkage and alleviating symptoms. Only a tiny nick on the skin is needed to allow insertion of a small, 1 – 2mm diameter catheter into the femoral artery in the groin. This catheter is advanced into the arteries of the uterus under X-ray guidance.

A non-pregnant uterus weighs about 60 – 100 grams. During pregnancy, the uterus can enlarge enormously, opening up numerous blood vessels that are normally dormant. During UAE, small particles are injected to block the blood vessels supplying the uterus. Normal uterine tissue has plenty of dormant blood vessels it can recruit to remain alive and viable. However, as adenomyotic tissue does not have the capacity to recruit dormant vessels and is starved without oxygen and nutrients, it will therefore shrink and die.

UAE is a minimally invasive procedure, especially when compared with a hysterectomy. Symptoms can be effectively treated without the requirement to surgically remove the uterus. Risks of blood transfusion, wound infections and other potential complications are eliminated and there is no need for general anaesthetic. UAE also requires a shorter hospital stay (1 – 2 days versus 5 – 7 days) and much shorter convalescence (1 week versus 4 – 6 weeks) before returning to work or normal activities.

No. UAE has been long been used to treat postpartum haemorrhage. UAE for fibroids has been performed since 1995. Many studies have demonstrated safety and effectiveness in treating adenomyosis symptoms. Our own studies published in the 2018 ANZ Journal of Obstetrics and Gynaecology was one of the largest case series and reported the highest clinical success rate.

The UAE procedure itself is essentially pain-free. Local anaesthetic at the groin may sting for about ten seconds before taking effect. Soon after embolisation, pain (like period pain) may be experienced. The degree varies from person to person.

Our robust pain control protocol has worked well for many previous patients for more than ten years, including patient-controlled analgesia (PCA) administered through an IV drip. Pain is usually worst for the first 12 hours and PCA is not usually required the following day.

Take home medications typically include regular Panadol and nonsteroidal anti-inflammatory drugs (NSAIDs). Additional long and short acting pain medications are also supplied. Pain should subside within 4 – 5 days and patients should anticipate returning to normal activities about 7 days after the procedure.

UAE is a minimally invasive procedure. It is very safe, especially when compared with major surgery.

Procedural-related complications, such as spillage of particles away from uterine artery and vessel injury at the groin are very rare, each occurring in less than 1% of patients. Infection of the uterus (endometritis) is also rare (3%). Bladder infection related to catheterisation is 
also around 3 %. This infection can be treated with oral antibiotics. No major complications have been reported in our studies.

Transient loss of periods may occur in 5 – 10% of patients after UAE. Younger patients tend to regain their period within six months.

Ovarian failure resulting in menopause occurs in 1- 3% of women younger than 40, but more frequently (7- 14%) in women aged 45+. This may reflect the fact that women in their mid-40s and up are already nearing menopause.

This is a complex issue, which currently lacks research data in this area. It is known that pregnancy with adenomyosis may be difficult. There is a higher rate of miscarriage and pre-term delivery, and a lower success rate with IVF.

Pregnancy after UAE for adenomyosis can be complicated. A uterus with adenomyosis is not normal to start with. One cannot be sure if the problem with fertility and pregnancy is related to the pre-existing adenomyosis or the UAE treatment. UAE can be used as an uterine-preserving procedure to treat symptoms of adenomyosis, but is yet to be shown as a fertility-enhancing procedure. Therefore, fertility and pregnancy cannot be guaranteed. In other words, it is highly likely that the uterus can be conserved after UAE, but we cannot predict how well the uterus will carry a pregnancy. We do however have many cases of successful pregnancies after UAE for adenomyosis.

Yes. International studies and Sydney Fibroid Clinic’s own experience have demonstrated UAE (also known as UFE) is highly effective for fibroids as well.

 In fact, around 50% of women treated for adenomyosis also have one or more fibroids. Both adenomyosis and fibroids are common, and therefore they quite often coexist.

More information on Sydney Fibroid Clinic’s fibroids treatments can be found here.

UFE For Fibroids

The PVA (Polyvinyl Alcohol) particles used for UAE are made from pure plastic, with no additives. Pure plastic is inert, meaning it doesn’t interact, chemically or biochemically, with our body. There are many commercially available blocking (embolic) agents thatcan be used for UAE. We have chosen PVA and have been using it to treat fibroid and adenomyosis for nearly 15 years without any issues.  PVA is biocompatible and chemically stable ( ie not breaking down to harmful molecules). PVA is used in making contact lenses and medication capsules. PVA has been used as an embolic agent since the 1970s. There have been no safety issues raised or reported regarding the use of PVA particles. PVA particles are lodged and trapped in the small blood vessels that they block and become part of the scar tissues that are formed following the death of adenomyotic tissue, so they will not end up elsewhere in the body.

Plastics as a material is a concern for many people. Plastics have got a bad name due to the additives put in by the manufacturers. To solidify plastic products, they add reinforcing agents, such as bisphenol A (BPA), and plasticizers, such as phthalates, to make them soft and flexible. During the production of furniture and electronics, fire retardants are added to make them less flammable. Altogether there are many plastic additives that consumers come into contact with on a daily basis, some of which are harmful to your health and have been found in human urine and blood. For example, BPA is suspected of causing hormone disruption and is associated with metabolic and reproductive diseases, as well as cancers.

The pure plastic (PVA) that we use for UAE does not have additives and therefore safe.

If you’re troubled by the symptoms of uterine adenomyosis and conservative treatments have not been effective, UAE could be an ideal treatment – especially if you wish to avoid a hysterectomy.

For more information on whether you’re a suitable candidate for UAE, call to discuss or book a consultation with Dr Eisen Liang.

Enquire About Adenomyosis Treatment

All patients are required to have a pre-procedure consultation with Dr Liang. This allows us to obtain a gynaecologic and general medical history, review imaging findings and discuss the procedure with you.

If your ultrasound is uncertain about the diagnosis or a tumour (fibroid) is reported,  MRI of the uterus is also required to confirm the diagnosis of adenomyosis and to make sure the fibroid is not cancerous. We require the MRI be done at our appointed facilities that are familiar with uterine imaging and reporting. An MRI is the most accurate imaging test in assessing uterine pathologies and MRI is also used as a baseline for follow-up comparison at six months.

On the day of your procedure, you’ll need to avoid solid food for 6 hours. Clear fluid and medications are allowed up until the time of procedure.

Nursing staff will start an intravenous line to give you fluid, sedatives and pain relief medications. We’ll also need to place a catheter in your bladder, to ensure your bladder remains empty during the procedure. As your bladder is in front of your uterus, X-ray dye collected in the bladder will obscure our view.

After your procedure, you’ll need to lie still for 2 hours to prevent bleeding in the groin.

You may experience pain and nausea. Medications are prescribed to control these symptoms and you may ask the nurses if you require them. The pain is worse in the first 12-18 hours. You’ll be given a patient-controlled analgesia (PCA) pump that allows you to administer the doses you need. You are allowed to eat and drink, but you might be nauseous and you might not have any appetite.

Typically, you will no longer require the PCA the next morning and the bladder catheter can be removed to allow you to move around and to shower. The majority of our patients are able go home, though some might need to stay another night until the pain is under control and oral fluid intake is adequate.

Take home medications typically include regular Panadol and nonsteroidal anti-inflammatory drugs (NSAIDs). Additional strong pain medications are also supplied. Coloxyl with Senna is also provided to prevent constipation.

In the next few days, you may experience residual pain, lethargy and low-grade fever. You should be well enough to go to the local shops on days 4 – 5. You should anticipate returning to work and normal activities about 1 week after your procedure.

Some vaginal discharge and minor bleeding is normal after UAE.

We will touch base with you via email at 3 months post UAE to check your clinical progress. You’ll need to see our doctors for review at 6 month with a progress MRI ( unless you only had ultrasound prior to UAE).

Sydney Fibroid Clinic believes in a multidisciplinary approach to deliver the best care for adenomyosis-related symptoms. Therefore, we share the care with your GP and gynaecologist.

You might have seen your own gynaecologist, who may or may not be familiar with UAE. Dr Liang is happy to discuss your case with your gynaecologist if he or she wishes to do so. Otherwise, we are happy to see you to provide you with a second opinion.

If you have not seen your own gynaecologist, Dr Liang is willing to see you and discuss all your treatment options. If necessary, Dr Liang will invite his gynaecologist associate to conduct a joint consultation to discuss your case.

There have been no major complications from UAE for adenomyosis. Some women with large focal adenomyosis may shed tissue debris as brownish vaginal discharge – but as long as there is no bad odour to suggest infection, antibiotics will not be needed.

The typical symptoms of uterine adenomyosis include heavy menstrual bleeding, severe period pain, bloating sensation, chronic pelvic pain and pain during sex. When examined by a doctor, the uterus is typically bulky and tender to touch.

Transvaginal ultrasound can detect adenomyosis but the signs could be subtle and easily missed. When fibroids are also present, adenomyosis is often mistaken as fibroids.

Adenomyosis is easier to see on MRI than ultrasound. The extent and location of adenomyosis is clearly mapped on the MRI.  Adenomyosis are much better distinguished from fibroids on MRI than ultrasound.

Unfortunately MRI of the uterus for non-cancerous conditions are not funded by Medicare.

Generally speaking, adenomyosis is not suitable for surgical removal. Adenomyosis is an infiltrative process. Unlike fibroids, which can be easily separated from the normal uterine wall, adenomyotic tissue does not have a clear boundary with the normal myometrium.

Surgeons find it difficult to determine where adenomyosis stops and where the normal myometrium begins. The removal is either incomplete, leaving behind adenomyotic tissue – which can continue to grow and cause problems – or larger than necessary, so that the excessive amount of normal uterus is removed.