**3.2 Study participants**

A total of 64 patients met the inclusion criteria, with a mean admission age of 51 years (36–53). 40 patients (62.5%) were diagnosed with pure adenomyosis, 10 patients (15.62%) with focal adenomyosis (adenomyoma) and 14 patients (21.87%) with adenomyosis and fibroids. 50 participants (78%) had a history of pregnancy and childbirth in the past.

Reported symptoms included: dysmenorrhea (98%) with a mean VAS score of 8.8 (range 6–10), menorrhagia with menstrual clots (88%), menorrhagia without menstrual clots (53%) and urinary problems (12%). In terms of quality of life data, 76.5% of women complained of limited daily activities and low energy due to heavy menstrual bleeding, while 73.5% had problems with their sex life.

#### **Figure 3.**

*Mixed type adenomyosis, myomas predominate, pressing and repelling the endometrium. MRI section, T2-WI, Sagital. Notice the increase in the width of the myometrial transition zone and hemosiderin granule (arrow) in the enlarged transition zone.*

### **3.3 Results**

According to our results, we confirm the following data:

Successful embolization (100%) was observed in all participants. On average, patients spent two days in the hospital, one day before the procedure and one on the day of the intervention. Elimination of clinical symptoms and reduction in pelvic pain intensity, assessed using VAS, was observed in 62 participants (96.87%). Pain in these cases decreased by an average of 7.5 points (from 8.2 to 1.0 points) during the follow-up period (from 1 to 12 months, average 3 months). Severe pain immediately after embolization and for approximately 24 h was observed in 8 cases with diffuse adenomyosis, 4 cases with adenomyoma and 2 cases with coexisting adenomyosis, in which analgesics and non-steroidal anti-inflammatory drugs were administered. In the majority of participants in our study, there were no significant complications associated with the procedure. However, in 4 participants (6.2%) recurrence of pain was observed within one to 2 months after embolism. In these cases, fractional dissolution is required, because submucosal fibroids coexist and adenomyosis diffuses. A postpartum neonatal ward of focal adenomyosis, sepsis, and surgical resection of necrotic sections was established, subject to the uterus. In no case was either reoperation or hysterectomy required. Restoration of normal menstruation was immediately observed in the subgroup of participants under 45 years of age. The other subgroup, which included participants over the age of 45, had normal menstruation. Only in 93% of cases immediately and only in 4 participants reported experience of the absence of menstruation for at least 3 months after embolization, resulting in the appearance of the period later after three months than in the other participants. In participants of the older participants over 45 years

*Uterine Embolization as a New Treatment Option in Adenomyosis Uteri DOI: http://dx.doi.org/10.5772/intechopen.101480*

#### **Figure 4.**

*MRI section, T2-WI, Sagital of the patient, six months after bilateral embolization. The myomas have completely degenerated and shrunk, however they continue to repel the endometrium to a lesser degree. The myometrial band anatomy has been restored to normal. The examination was performed with sections T2-WI, D-WI and T1-WI, simple and with spectral suppression of the magnetic fat signal, before and after intravenous administration of paramagnetic substance—situation after UAE 6 months ago. Degeneration, complete elimination of vasculitis and very significant further shrinkage of the two submucosal myomas, degeneration, ischemia and mild further shrinkage of the subarachnoid myoma of the anterior myometrium are observed, while the muscles of the fibroids are completely indistinguishable. The (normal) endometrium is slightly repelled by the two submucosal myomas. In the present examination, the uterus, which has been reduced in size, is presented with normal belt anatomy. Normal imaging of the cervix—a little free peritoneal liquid is shown in the Douglas pouch—the ovaries are normal—no pathological lymph nodes are not detected.*

#### **Figure 5.**

*Hyperelective catheterization and imaging before embolization of the left uterine artery, using a microcatheter. Observe the spiral vessels of adenomyosis and the straight lines of the myomas.*

#### **Figure 6.**

*Hyperelective catheterization and imaging before embolization of the right uterine artery, using a micro-catheter.*

with a delayed onset of menstruation, low levels of AMH were established depending on biological age. Based on the findings of the MRI, partial or complete restoration of the normal zone anatomy in the uterus was confirmed after 6 months. All participants reported a decrease in menstrual bleeding and consequently improvement of everyday life quality. In one woman aged 49 years old, the decrease was not satisfactory and she underwent two months of analgesics therapy and after that the clinical symptoms were successfully improved. In our participants, the avoidance of hysterectomy was achieved in 100% of the women. All participants reported to be very or fairly satisfied with the results and would recommend this treatment to colleagues and friends.
