Uterine artery embolization (UAE) is a great alternative to conservative surgical procedures like hysterectomy with its highly promising results, low recurrence, and considerably shorter hospitalization period.
Uterine artery embolization is a minimally invasive procedure that is performed to stop pelvic bleeding that might be caused by either uterine adenomyosis, uterine fibroids, cancerous tumors, trauma or injuries amongst other conditions. Among these, adenomyosis is a common pathophysiological condition in women of reproductive age that leads to distressing conditions which affect our daily performance and interactions. Although a major chunk of our population of approximately 20% to 80% are affected by this gynecological problem, adenomyosis still remains highly under-recognized and under-researched disease. Therefore, it is important to spread awareness regarding this condition and its treatment plans to help those that are suffering in silence.
Uterine Adenomyosis – Overview
Adenomyosis is an often-misunderstood benign gynecological condition in which the lining of the womb or uterus that should be on the inside invades and get embedded into the muscular wall of the uterus and is primarily seen in women of ages between 30 and 50 years.
Uterine Adenomyosis Symptoms
As all of us act differently in similar situations, women affected by adenomyosis may be completely asymptomatic, which allows the disease to go unnoticed until the case becomes severe. However, on the contrary, a bunch amongst us experience symptoms that vary in severity, making it hard for them to go on about their daily business without any discomfort and difficulty. Since the symptoms of adenomyosis overlap considerably with those of uterine fibroids, people tend to confuse one with each other. Adenomyosis symptoms that are most frequently noticed in the affected women include intense fatigue, menorrhagia (heavy menstrual bleeding), dysmenorrhea, pelvic pain, and irritation in the bladder due to inflammation caused by the shedding of the invasive adenomyosis tissues in the uterus. Other symptoms may include abdominal bloating due to uterus enlargement, dyspareunia (painful intercourse), anemia and iron deficiency due to heavy monthly bleeding, irregular menstruation cycle while some also experience fertility issues.
Uterine Adenomyosis Causes
Being as under-researched as it is contrary to the affected population, the definitive root cause and pathogenesis of adenomyosis is yet to be discovered. Regardless, researchers have pinned down quite a few theories that could be the culprit behind its origin.
Age: Since this condition has been observed commonly in women over 40 years of age, it has might be linked with the aging process.
Surgical Procedures: It’s been seen that women who have had children especially through caesarean delivery or have previously undergone any uterine fibroid surgery or any intrauterine procedure are more at risk of developing uterine adenomyosis.
Invasionof Uterine Cells: Adenomyosis could develop due to the invasion of endometrial cell into the uterine muscular walls due to either an incision made during uterine surgery or during normal physiological conditions.
Inflammation: Inflammation associated with tears and incisions made during normal childbirth.
Fetal origin of extra tissues in the uterine wall that set down before birth and grow during adulthood.
Metaplasia of stem cells in the uterus, which is the differentiation of one type of adult cell into another type.
Earlier to deciding the treatment regime, it is necessary that definitive diagnosis of adenomyosis is performed. This may include physical examination to check for any uterine enlargement and tenderness, along with different imaging techniques like ultrasound and MRI. There are two options for its treatment, medically and procedurally depending on different factors such as your symptoms, severity of the disease and personal preferences. Below are a few treatment plans described that are used frequently to treat adenomyosis symptoms.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to relieve adenomyosis associated pain.
Hormonal Therapy: Hormonal therapies have been suggested to control symptoms such as heavy or pain during by prescribing medicines like levonorgestrel-releasing intrauterine device (a contraceptive method), aromatase inhibitors, Gonadotropin-releasing hormone analogs and estrogen-progestin therapy.
Endometrial Ablation: This is a minimally invasive procedure in which the lining of the uterus is destroyed.
Hysterectomy: If you have surpassed child-bearing age or are ready to undergo surgery that removes the whole uterus to relieve the symptoms once and for all, then hysterectomy is another option.
Uterine Artery Embolization: Also known as uterine fibroid embolization (UFE), is an innovative outpatient procedure that has been established in 1995 as a beneficial treatment option for symptomatic uterine fibroids. Since then, the procedure has been established and is also used for the treatment of adenomyosis through adenomyosis embolization, which has shown favorable outcome.
It is a highly effective and essentially pain-free procedure performed by an interventional radiologist. Local anesthesia at the groin is applied, which may not even sting as prior to giving local anesthesia anesthetic spray is used over the access site.Specialized micron size particles are injected through a tiny tube inserted into the uterine artery that block the blood flow to the adenomyosis affected area. The procedure is guided through real-time fluoroscopy to direct the tube. The micron size particles then aid in shrinking down the invasive muscular growth that is the characteristic of adenomyosis by cutting off the blood supply to the affected area. Soon after embolization, pain (menstrual pain) may be experienced, however it will subside. You could feel the symptoms alleviate after the procedure. Being minimally invasive in nature, risks associated with surgical procedures such as wound infections and post-procedure complications are eliminated.
Uterine Artery Embolization is now available in Pakistan for the first time since 2017, as a 3-D precision guided endovascular treatment in two of its major cities; Karachi and Lahore. The embolization procedure is carried out using an FDA approved devices and medications by Dr. Imtiaz Ahmad, who is a renowned interventional radiologist and endovascular surgical specialist. As a part of post-treatment practice, the patient can expect a follow-up up to 6 months. There are numerous success stories of patients that underwent UAE procedures performed by Dr Imtiaz Ahmed that speak for his expertise in this area without compromising your fertility.
Even with improvements in the medical diagnostic technologies with their high resolution, adenomyosis remains a highly under-recognized and under-researched gynecological disease which affects about 20% to 88% of women of reproductive age. Therefore, it is important to shed light on this condition that many of us live with even without having any diagnosis. It can significantly affect the work and quality of life of those suffering, to the extent where it causes extreme tiredness and also affects daily performance. However, this condition resolves by itself as women reach menopause.
A Brief Overview of Adenomyosis
Adenomyosis is a benign uterine condition characterized by an enlarged uterus. It is a condition in which the endometrium, which is the inner lining of the uterus, grows into the outer muscular wall of the uterus (myometrium). The development of this extra tissue thus causes the uterus to grow in size, leading to abnormal uterine bleeding. Where, adenomyoma of endometrium is a type of adenomyosis are focal benign lesions or growths that blend with the myometrium and is rather difficult to distinguish from fibroid growth.
Adenomyosis and endometriosis are both uterine diseases that affect endometrial tissues that can be confused with one another or coexist in females that have been diagnosed with endometriosis. In both conditions the symptoms overlap considerably however, they are not the same. In endometriosis, the inner lining of the womb (endometrium) grows outside of the uterus and can breach the organs nearby, making it hard to conceive. Whereas in adenomyosis, the endometrium grows inside the uterine muscular wall. Thus, they affect different body parts while sharing a number of symptoms making it unavoidable to confuse them with one another.
What Causes Adenomyosis
Although the etiology and pathogenesis of adenomyosis are largely unknown till date, researchers have pinned down a few theories. It’s been observed commonly in women over 40 years of age, who have had children or undergone any fibroid surgery, are more likely to be suffering from this disease.
Invasion of endometrial cells into the uterine walls. This could be either due to an incision made during uterine surgery or during normal conditions as well.
Inflammation associated with childbirth.
Fetal origin of extra tissues in the uterine wall that set down before birth and grow during adulthood.
Metaplasia (differentiation of one type adult cell into another type) of stem cells in the uterus.
Adenomyosis Associated Symptoms
Adenomyosis symptoms vary from women to women. While some might not feel any symptoms at all, other may have it hard for them to endure. Several main symptoms associated with adenomyosis that include:
Heavy menstrual bleeding
Dyspareunia (painful sexual intercourse)
Anemia or iron deficiency due to heavy bleeding
Adenomyosis and Cancer
Although adenomyosis is generally considered a benign condition, studies have suggested increased potential of developing uterine cancer such as endometrial and ovarian cancer in such patients due to the risk of malignant development of endometrium. Generally, the symptoms associated with uterine cancer include weight loss, painful intercourse, unusual vaginal discharge, pain in the pelvic region and painful urination.
Adenomyosis Treatment Options
Before treatment, definitive adenomyosis diagnosis is necessary for which your healthcare professional will want to perform a diagnostic evaluation which will include a physical exam and diagnostic imaging test such as an ultrasound or MRI scan to determine uterus enlargement, tenderness to palpation and location of invasive growths respectively.
Your treatment plan will in part depends on your symptoms, disease severity and personal preferences. The available adenomyosis treatment options are discussed briefly, herein:
Medications: You might be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve adenomyosis associated pain. Which are prescribed to be taken one to two days before the beginning of menstrual bleeding and is continued through the first few of the cycle.
Hormone Therapy: Hormonal therapies are suggested to control symptoms such as heavy or pain during by prescribing medicines like levonorgestrel-releasing intrauterine device (a contraceptive method), aromatase inhibitors, Gonadotropin-releasing hormone analogs and estrogen-progesterone treatment.
Endometrial Ablation: In this minimally invasive procedure, lining of the uterus is destroyed. Even though, the procedure does not involve surgery, the process will result in infertility, which is what most women of childbearing age would not prefer.