Uterine artery embolization (UAE) is an effective, minimally invasive treatment for fibroids that helps most women avoid surgery, with 79.5% remaining free of hysterectomy at five years, even when adenomyosis is present.
- 79.5% of women with fibroids and adenomyosis avoided hysterectomy at five years after undergoing UAE, demonstrating the procedure's long-term effectiveness
- No significant difference in safety between patients with fibroids alone and those with coexistent adenomyosis within 30 days of the procedure
- 41% higher risk of eventual hysterectomy occurred in patients with coexistent adenomyosis compared to fibroid-only cases, though most still avoided surgery
- Study included 13,098 patients aged 30-55 years tracked between 2013-2025, making it one of the largest comparisons of UAE outcomes
- Pre-procedural counseling is recommended to help patients understand the small risk of future hysterectomy and set realistic expectations for treatment success
Image-guided uterine artery embolization (UAE) has similar outcomes for patients whether or not coexistent adenomyosis is present, according to findings published November 7 in the Journal of Vascular and Interventional Radiology.
However, coexistent adenomyosis is tied to a higher hazard rate of hysterectomy, though most patients with this condition avoid definitive surgery, wrote researchers led by Tarub Mabud, MD, from Columbia University Medical Center in New York.
“Few studies have directly compared reintervention after UAE between isolated fibroids and coexistent disease, but existing data indirectly support these findings,” Mabud and colleagues wrote.
Despite growing evidence of UAE’s effectiveness in treating fibroids while avoiding surgery, the researchers pointed out limited data on adenomyosis. This means clinicians cannot reliably estimate how coexistent adenomyosis affects UAE’s periprocedural risk profile or whether it leads to more reinterventions.
The Mabud team compared short-term safety and long-term durability of UAE in patients with fibroid-only disease versus those with fibroids and coexistent adenomyosis. The study included 13,098 patients aged 30 to 55 years within the MarketScan Commercial Database who underwent UAE between 2013 and 2025.
The researchers reported the following findings:
No statistically significant difference in 30-day major adverse events occurred between both groups, with an adjusted odds ratio of 1.20 (p = 0.24).
Compared to patients with fibroids alone, patients with coexistent fibroids and adenomyosis faced a 41% higher hazard of hysterectomy (hazard ratio [HR] = 1.41; p = 0.001) and a 21% higher hazard of any reintervention (HR = 1.21; p = 0.05).
Only the hysterectomy association remained significant in all sensitivity analyses.
At five years, hysterectomy achieved a cumulative incidence of 20.5% versus 13.9% for fibroids only.
Finally, composite major adverse events occurred in 4.3% of patients overall within 30 days of the index UAE.
Despite these findings, most patients with coexistent disease avoided definitive surgery, with 79.5% free of hysterectomy at five years. The researchers noted that estimates beyond five years were limited by short median follow-up and fewer patients remaining at risk.
The results point to UAW being a uterus-preserving option in this patient population, the study authors wrote. They advised that pre-procedural counseling would best address the topic of subsequent hysterectomy.
Read the full study here.
