*2.1.2.1 Indications*

(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 cannot be passed.

#### *2.1.2.2 Contraindications*

(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,

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*Interventional Treatment of Endometriosis DOI: http://dx.doi.org/10.5772/intechopen.93054*

mainly supplied by the ovarian artery [9].

expected effects, and potential complications.

*2.1.3.3 Clinical evaluation criteria for menstrual volume*

*2.1.3.4 Examination before treatment*

treatment, the menstrual volume was not significantly reduced.

*2.1.3 Preoperative evaluation of UAE*

*2.1.3.2 Evaluation of dysmenorrhea*

*2.1.3.1 History and evaluation*

puncture site skin infection, renal insufficiency, or severe immunosuppression of the body; and (5) patients with uterine fibroids or adenomyosis whose lesions are

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,

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%.

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

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.

puncture site skin infection, renal insufficiency, or severe immunosuppression of the body; and (5) patients with uterine fibroids or adenomyosis whose lesions are mainly supplied by the ovarian artery [9].
