For Adenomyosis (uterine endometriosis)
Adenomyosis has been a frustrating disease to treat;
Medical treatment- Oral progesterone or birth control pills often does not work. The progesterone-containing IUD (Mirena) can help with menstrual cramping for short time in about 40 to 50% of women. The most common side effects from the IUD were weight gain (29%), benign ovarian cysts (22%) and lower abdominal pain (12%). Hysterectomy (surgical removal of uterus) is the only treatment option left.
Experiencing any symptoms such as pain or intense bleeding are signs you should get to the doctor immediately to be checked out. The quicker you can get a diagnosis then the quicker you will be able to find appropriate treatment.
Non-surgical Treatment- Uterine artery embolization for Adenomyosis
Minimally Invasive treatment: It is a minimally invasive interventional radiological procedure, which means it requires only a tiny nick in the skin. It is performed under sedation or mild local anesthesia, feeling no pain and usually requires a hospital stay of one night. Many women resume light activities in a few days and the majority of women are able to return to normal activities within a week.
Benefits of uterine artery embolization
- It can treat focal or diffuse adenomyosis.
- It can treat adenomyosis associated with single/multiple fibroids
UAE treats focal and diffuse adenomyosis and all uterine fibroids at the same time and is, therefore, an extremely effective.
The interventional Radiologist makes a small nick in the skin (less than half of an inch) at groin, inserts a catheter, identifies uterine artery by using angiography with contrast media injection and then inject embolization particles (polyvinyl alcohol) that block the tiny vessels supplying adenomyosis and all the fibroids. This blockade of blood supply to abnormal endometriotic tissue and fibroids causes infarction) and subsequent degeneration of the adenomyotic tissue. In a few week uterus start reducing in size. Symptoms like bleeding and pain resolve in 85% to 95% of patients.
A) Embolization preparation. A tiny angiographic catheter is inserted through a nick in the skin in to an artery and advanced into uterus. B) Injection. Tiny polyvinyl alcohol particles of 500 um in diameter are wedge in the small arteries, blocking the blood flow to the fibroids.
Uterine artery embolization has many Indications:-
- Focal or diffuse adenomyosis.
- Single / multiple Uterine Fibroids.
- Failed myomectomy/recurrence of fibroids after myomectomy
- High-risk patient for surgery like obesity, anemia, chronic renal failure etc.
- Postpartum Hemorrhage
- Bleeding from Cancer of Cervix & Uterus
- Pre-operative embolization to reduce bleeding during uterine surgery.
Advantages of Uterine artery embolization
- It is performed under mild sedation feeling no pain.
- Requires only a tiny nick in the skin (No surgical incision on abdomen).
- Recovery is shorter than from hysterectomy or open surgery
- Virtually no adhesion or scar formation has been found. But in surgery adhesions are common.
- Adenomyosis and all fibroids if present in uterus are treated all together in one sitting, which is not the case with surgery.
- The overall successes rate is about 95%.
- Uterine artery embolization involves virtually no blood loss or risk of blood transfusion.
- If the presenting complaint was severe pain & excess vaginal bleeding, 90-95% of cases experiences resolution within 24 hours.
- Emotionally, financially and physically , embolization can have an overall advantage over other procedures for the patient as the uterus is not removed
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