*2.1.3.1 History and evaluation*

*Endometriosis*

option for patients with uterine fibroids who wish to preserve the uterus (level A evidence) [3]. Therefore, UAE has been widely used in the treatment of uterine leiomyoma, and then UAE has achieved significant effect in the treatment of pain and anemia symptoms of adenomyosis, but there is controversy in the use of adenomyosis, which may recur after a period of time due to symptoms [4]. In recent years, more and more literatures show that UAE is effective in the treatment of adenomyosis, especially in the short term [5–7]. UAE treatment alleviated the symptoms of

Adenomyosis is a diffuse or local proliferation of surrounding smooth muscle and fibrous connective tissue caused by glandular and stromal invasion of the basal layer of the endometrium, and the ectopic endometrium is in the proliferative phase due to its origin from the basal layer of the endometrium. The above lesions have a relatively rich network of new blood vessels and poor tolerance to ischemia and hypoxia, but the normal uterine tissue has a rich vascular traffic network, and the normal uterus has a strong tolerance to ischemia and hypoxia. Embolization of the vascular network of the lesion through the uterine artery blocks the blood supply of the lesion (after), resulting in ischemic necrosis of the lesion, followed by dissolution and absorption, and finally the lesion shrinks or even disappears, while the reduction of the lesion reduces the uterine volume and uterine cavity area, which can effectively reduce the menstrual volume, so as to achieve the purpose of relieving symptoms.

(1) Patients are willing to undergo UAE treatment and understand the relevant possible complications. (2) Symptomatic adenomyosis without fertility requirements, including dysmenorrhea and heavy menstrual bleeding. (3) Patients with uterine adenomyosis who fail non-surgical treatment or refuse surgery or have a history of multiple surgeries and are difficult to treat by reoperation. (4) Patients with pelvic endometriosis (including ovarian endometrioma) at the same time, need to inform UAE is ineffective for the above disease, in patients with full understanding and requirements, the option of UAE treatment of adenomyosis combined with laparoscopic treatment of pelvic endometriosis (including ovarian endometrioma). (5) Patients with symptomatic uterine adenomyosis who have fertility requirements should use UAE with caution. In terms of indications, we have repeatedly stressed that UAE should be carefully selected for patients with adenomyosis who have fertility requirements. The reason is that the medium- and long-term effects of UAE on endometrial microcirculation or intrauterine environment is still uncertain. UAE needs to be performed under X-ray. The skill level of the operator and the vascular condition of the patient are linear, which will affect the amount of radiation received by the patient, and the effect of radiation on the fertility rate is also uncertain. This kind of research is rare, because it involves ethical review and

(1) Pregnant women; (2) combined with genitourinary system infection; (3) known or suspected gynecological malignant tumors coexist; (4) general contraindications of interventional embolization therapy, such as contrast agent allergy,

adenomyosis and made most adenomyosis patients retain the uterus [8].

*2.1.1 Rationale for UAE in uterine adenomyosis*

*2.1.2 Indications and contraindications of UAE*

*2.1.2.1 Indications*

cannot be passed.

*2.1.2.2 Contraindications*

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These include detailed gynecological history, such as menstrual history, previous pregnancy, fertility plan, gynecological disease, and previous pelvic surgery, medical history to identify various comorbidities, and previous use of anticoagulants. Adequate informed consent is required, and informed consent for surgical procedures is signed to understand the advantages and disadvantages of treatment, expected effects, and potential complications.
