*2.1.3.2 Evaluation of dysmenorrhea*

A comprehensive assessment of the degree of recent and long-term dysmenorrhea in patients with adenomyosis was performed using the visual analog scale (VAS) for pain and the chronic pain rating scale. The clinical evaluation standard of dysmenorrhea symptoms: the degree of dysmenorrhea was evaluated by chronic pain rating scale before and after operation. We used VAS to evaluate the degree of dysmenorrhea at each follow-up time point, and VAS weighted calculation method to evaluate the efficacy of UAE in the treatment of dysmenorrhea in adenomyosis. Effective: the postoperative dysmenorrhea disappeared or the postoperative dysmenorrhea symptoms existed, but the score of chronic pain rating scale decreased by two or more levels, (1) cured: (preoperative VAS score − postoperative VAS score)/preoperative VAS score × 100% ≥ 75%; (2) effective: (preoperative VAS score − postoperative VAS score)/preoperative VAS score × 100% ≥ 50% and < 75%; (3) effective: (preoperative VAS score − postoperative VAS score)/preoperative VAS score × 100% ≥ 25% and < 50%. No effect: the symptoms of dysmenorrhea after operation exist, the score of chronic pain rating scale is only reduced by one grade, or the dysmenorrhea is not relieved or even continues to increase, or (preoperative VAS score − postoperative VAS score)/preoperative VAS score × 100% < 25%.

## *2.1.3.3 Clinical evaluation criteria for menstrual volume*

Menorrhagia was defined as menstrual flow >80 ml per menstrual cycle (more than 20 sanitary napkins were used); oligomenorrhea was defined as menstrual flow <5 ml per menstrual cycle (less than 1 sanitary napkin was used). Clinical evaluation standard of menstrual volume: subjective symptoms of patients. Significant effect: after UAE treatment, menstrual volume decreased significantly. Effective: after UAE treatment, menstrual volume decreased. No effect: after UAE treatment, the menstrual volume was not significantly reduced.

### *2.1.3.4 Examination before treatment*

In addition to routine preoperative examinations, sex hormone levels were measured to assess ovarian function. Because the influence of uterine artery embolization on ovarian function is uncertain. Blood CA125 levels were measured for follow-up, CA125 was used as a follow-up index because we found that most patients with adenomyosis have different degrees of increase in this index.

#### *Endometriosis*

The reason is that the serum CA125 antigen of patients with this disease is secreted by ectopic endometrium between muscles, and CA125 molecules on the surface of endometrial cells are released into the blood circulation, which increases the concentration of CA125 antigen in the blood. Several studies [10] also show that serum CA125 assay is of great assistance to the diagnosis of uterine adenomyosis. Blood CA125 levels were measured for follow-up. Venous color Doppler ultrasonography of both lower limbs is particularly important to assess the presence or absence of preoperative thrombosis.
