Uterine Artery Embolisation for Adenomyosis & Fibroids - Minimally Invasive Treatment
Uterine adenomyosis is a condition where endometrial tissue lines the uterus grow into the uterine muscle (myometrium). This thickens the uterine walls and causes a host of symptoms like heavy periods, severe menstrual cramps, blood clots and chronic pelvic pain. Uterine fibroids are non-cancerous tumours that form on the uterus. They often occur in clusters, and cause painful periods, vaginal bleeding between periods, irregular menstrual cycles and pressure in the lower belly. Uterine adenomyosis and fibroids share many symptoms, making it difficult to diagnose without further investigation. Typically, doctors will require an ultrasound scan, an MRI scan and an endometrial biopsy to arrive at a diagnosis. Some patients may also have to undergo a pelvic laparoscopy.
Uterine adenomyosis and fibroids can be treated with uterine artery embolisation. This is a minimally invasive procedure, performed via a small incision in the femoral or radial artery. During the procedure, the blood vessels supplying nutrition to the lesions or fibroids are blocked using embolic micro-beads. Once the blood supply is cut off, the lesions or fibroids shrink and stop causing symptoms over the next 3 to 6 months.
Uterine adenomyosis is a disorder in which endometrial tissue, that usually lines the uterus, starts to grow into the muscular uterine wall (myometrium). This causes the uterus to thicken, to almost 2 to 3 times its original size. The displaced endometrial tissue thickens, breaks down and causes menstrual bleeding every month, just like the normal endometrial lining. This causes severe discomfort. Adenomyosis can cause pain during periods, prolonged menstrual bleeding, clots in the period blood and severe pelvic pain. Uterine adenomyosis affects approximately 11 to 13% of women. Most patients are between the ages of 41 to 45 years old. Women who have given birth, have endometriosis or have prior surgeries for removal of uterine fibroids have an increased risk of developing uterine adenomyosis.
Uterine fibroids are growths or masses that form on the uterus. They are not cancerous and usually don’t become cancerous as they grow. They are also called leimyomas or myxomas. Fibroids vary in size and often don’t cause symptoms while small. Patients may have clusters of multiple fibroids or a single large fibroid. Some fibroids can grow as large as grapefruit and distort the inside of the uterus. In extreme cases, the fibroids can grow so large that they can make the patient look pregnant. Uterine fibroids are common, but most fibroids tend to be small and cause no symptoms or damage. They are often discovered during routine pelvic exams or ultrasound scans.
Fibroids often grow in clusters. The cluster sizes can range from 1mm to more than 200mm in diameter. Fibroids are categorized by location – Intramural fibroids are located inside the muscular uterine walls. Submucosal fibroids are formed in the uterine lining, projecting into the uterine cavity. Subserosal fibroids grow on the outside of the uterus. The risk of developing uterine fibroids increases with age, vitamin D deficiency, alcohol abuse and family history of fibroids.
Uterine adenomyosis causes painful, uncomfortable symptoms, especially during menstruation:
– Heavy, prolonged menstrual bleeding
– Irregular periods
– Pain during intercourse
– Chronic pelvic pain
– Swelling and tenderness in the lower abdomen
Uterine fibroids often don’t cause symptoms when small. Larger fibroids or clusters of fibroids may cause:
– Vaginal bleeding between periods
– Heavy menstrual bleeding, often with blood clots
– Prolonged periods
– Pelvic cramps or very painful periods
– Pressure in the lower belly
– Pain during intercourse
– Frequent urination
Uterine adenomyosis and fibroids share many signs and symptoms, making them difficult to diagnose using symptoms alone. The gynaecologist will proceed based on their observations during a pelvic exam. A transvaginal or transabdominal ultrasound is taken to produce images of the organs in the pelvis. These scans show thickening of the uterine walls or fibroids, including their location and size. The doctor may also require an MRI scan for more detailed images, to help decide the best treatment approach. In some cases, the doctor may also perform an endometrial biopsy, in which a sample of the tissue lining the uterine wall is collected for testing. This is done to ensure there are no cancerous growths, and that any fibroids that exist are benign. A pelvic laparoscopy may also be done to view the adenomyosis or fibroids up close.
Uterine adenomyosis symptoms tend to go away after menopause, as oestrogen production reduces. A hysterectomy can also stop the symptoms of adenomyosis. The course of treatment is decided based on severity of symptoms and how close the patient is to menopause. Uterine adenomyosis is treated with anti-inflammatory medication like ibuprofen a few days before and during the period. This helps reduce menstrual flow and relieve the severe cramping and abdominal pain. Some patients are also given hormone medication like combined oestrogen-progestin birth control pills or hormone patches. This also helps reduce bleeding and manage the pain and discomfort. Using intrauterine devices, progestin-only contraceptive pills or continuous-use birth control pills can also provide relief by stopping menstruation altogether. However, this is a symptomatic solution and doesn’t really address the root cause.
Treatment for uterine fibroids depends on the size, number and location of the fibroids, as well as the symptoms they cause. If there are no symptoms, the fibroids may not need active treatment and can simple be monitored at regular intervals. Fibroids that cause symptoms are treated with pain medication like ibuprofen or acetaminophen. The patient may also be prescribed iron supplements if the fibroids are causing anaemia. For larger fibroids, hormonal birth control pills or hormone shots may be given to attempt to shrink them. Gonadotropin-releasing hormone (GnRH) blocks progesterone and oestrogen, helping shrink the fibroids.
Uterine artery embolisation is a technique used to treat both adenomyosis and fibroids. Let us dive deeper into what this is and how it works.
Uterine artery embolisation is a minimally invasive interventional radiology technique that can be used to treat both uterine adenomyosis and fibroids. The technique uses tiny particles to block the arteries that supply the adenomyosis lesions or fibroids with nutrition. This stops their growth, causes them to shrink and drastically reduces the painful symptoms they cause. The procedure is performed by an expert interventional radiologist, under the guidance of real-time fluoroscopy to visualize the complex network of blood vessels.
The patient is usually given sedation or local anaesthesia during the procedure but is not under general anaesthesia. A catheter is also put in place to drain the bladder. The procedure is performed through a small incision in the leg (femoral artery) or the wrist (radial artery). A tiny needle and catheter are inserted into the incision and guided carefully to the areas of concern in the uterus, using real-time fluoroscopy. Once the specific blood vessels delivering blood to the lesions or fibroids are identified, they are blocked off with biocompatible embolic microbeads. Without blood supply, the lesions and fibroids shrink and eventually wither away over the next 3 to 6 months.
According to gynecologists, the entire uterine artery embolisation procedure takes about 45 minutes to an hour to perform. After the procedure, the patient will be advised to undergo hospitalization for the next 24 to 48 hours. The patient may experience some pain in the lower abdomen and the incision site during this time. Pain medication will be prescribed to treat this. The patient will be advised to take rest for about 2 weeks after the procedure. The symptoms do not dramatically stop right after the procedure but fade away slowly over the next 6 months. It is common to have watery, mucous-like discharge for a few weeks after the procedure. About 75% of patients who undergo uterine artery embolisation report a decrease in symptoms after the procedure.
Since uterine artery embolisation is a minimally invasive procedure, the risks associated with it are low. There are minor risks of internal bleeding, bruising and damage at the insertion site. However, this risk is very low when the procedure is performed by an experienced radiologist at a reputed hospital. Infections are also rare and can be treated with oral antibiotics. Some patients may experience post-embolisation syndrome a few days after the procedure. They typically have low-grade fever, nausea, pain, abdominal cramping, vomiting and extreme fatigue. If you experience any of these symptoms after the embolisation procedure, seek medical help immediately. Post-embolisation syndrome can be resolved with medication.
For expert care in treating uterine adenomyosis and fibroids, consider Kauvery Hospital. With branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, our team of highly skilled gynecologists and interventional radiologists is dedicated to providing personalized and effective treatment solutions. Trust us to guide you towards better health and comfort.
What is uterine adenomyosis?
Adenomyosis is when the tissue that normally lines the uterus grows into the muscular wall, causing thickened walls, heavy periods, and pain.
What are uterine fibroids?
Uterine fibroids are non-cancerous tumors that form on or in the uterus, often causing heavy bleeding, pain, and pressure in the lower abdomen.
How are adenomyosis and fibroids diagnosed?
They are diagnosed using pelvic exams, ultrasounds, MRI scans, and sometimes biopsies or laparoscopy to get a closer look.
What is uterine artery embolisation?
It is a minimally invasive procedure where tiny particles block the blood vessels that feed adenomyosis or fibroids, causing them to shrink over time.
How does embolisation help reduce symptoms?
By cutting off the blood supply, the fibroids and adenomyosis lesions shrink, which reduces pain, heavy bleeding, and other related symptoms over 3 to 6 months.
What is the recovery process after embolisation?
Patients usually stay in the hospital for 24-48 hours, may experience mild pain managed with medication, and are advised to rest for about 2 weeks as symptoms gradually improve.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801
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