**3. Our experience with UAE treatment in adenomyosis premenopausal women**

Between April 2008 and 2021 sixty-four premenopausal women from our department Obstetrics and Gynecology, with symptomatic adenomyosis (diffuse adenomyosis), focal (adenomyoma) or coexisting with uterine myomas in fourty cases, ten cases and fourteen cases respectively underwent uterine artery embolization (UAE) in cooperation with Interventional Radiology department of Democritus University of Thrace, Greece. All procedures were performed by the institutional ethical standards and with the 1964 Helsinki Declaration.

Informed consent was obtained from all individual participants included in the study. All study participants with adenomyosis with or without concomitant fibroids were assessed for treatment by an experienced gynecologist.

With a medical history, the main symptoms were divided into the following categories: menstrual bleeding, pelvic pain (rated on a VAS score from 0 to 10, with 0 representing no pain and 10 unbearable pain), urinary discomfort, bleeding pain, massive symptoms, combination despite previous treatment, and health-related quality of life effects (restrictions on daily activities, energy/mood, self-awareness, and sexual function). Each participant then underwent a gynecological clinical examination, also transvaginal ultrasound followed by an MRI study. All imaging findings [US/ MRI transvaginal ultrasound in either a Tesla 1 scanner (GE Healthcare) or a 1.5 Tesla magnet (Philips Multiva)] were then evaluated by an experienced gynecologist and invasive radiologist for possible treatment in the UAE. We present from our study participants Figures from a case with mixed adenomyosis and myoma uteri (**Figures 1**–**6**). Additional laboratory tests were performed that included platelet count, clotting time, and renal function markers (creatinine and glomerular filtration rate). All the methods and procedures followed in the present study obey the basic ethical rules. The study was

**Figure 1.** *Uterus myoma straight vessels.*

conducted under the Helsinki Declaration. After detailed information of the participants regarding treatment options by the gynecologist and the invasive radiologist, written consent from every single one of the participants was obtained. Study participants were admitted to the University Obstetrics and Gynecology Clinic one day before the uterine artery embolization and underwent laboratory tests. On the procedure day they were receiving intravenous chemoprophylaxis and in particular iv Augmentin 600 mg and iv Metronidazole 1 g, while four hours before the UAE a urinary catheter was placed. Following the procedure, all participants received additional analgesic treatment every 4 h (tramadol 100 mg) and were monitored at the Department of University Obstetrics and Gynecology.

The clinical results of the study were based on evaluations concerning the overall satisfaction of the patients, the relief of clinical symptoms, the need for reoperation and hysterectomy and the amenorrhea rates during the follow-up period, which varied from 1 to 12 months.
