Uterine artery embolization for the treatment of symptomatic adenomyosis: a systematic review

Adenomyosis is a benign uterine condition characterized by the presence of glands and endometrial stroma in the myometrium, with hypertrophy of the smooth muscle cells and uterine enlargement, and causing chronic pelvic pain, dysmenorrhea, and abnormal uterine bleeding, resulting in significant impairment of quality of life. In the last decades, the role of interventional radiology has expanded the range of treatment options of this condition, and uterine artery embolization (UAE) has emerged as a minimally invasive therapy in the management of symptomatic adenomyosis. This systematic review aims to evaluate the efficacy and safety of UAE in patients with symptomatic adenomyosis.

A systematic literature search was conducted across PubMed, Embase, Cochrane Library, Google Scholar, and Medline database, including studies published up to December 2025. Eligible articles included prospective and retrospective observational cohort studies with more than ten patients reporting UAE outcomes for adenomyosis; case report, case series, narrative or systematic review, meta-analysis, and guidelines were considered as not eligible and were therefore excluded. The data analyzed included patient characteristics, technical and clinical success, symptom improvement, imaging outcomes, reintervention rate, and complications, the latter classified according to the new modified CIRSE classification grading system.

Twenty-two studies met the inclusion criteria and we collected data on 1701 patients who underwent uterine embolization for therapy-resistant adenomyosis. UAE has demonstrated high technical success rates across studies with 1301/1701 (76.4%) patients experienced significant improvement in heavy menstrual bleeding, dysmenorrhea, and bulky-related symptoms at short- and mid-term follow-up. Imaging assessments showed reductions in uterine volume and junctional zone thickness; reintervention and hysterectomy rates were low. Reported complications were predominantly minor, with a low incidence of major adverse events. The mortality rate post-procedure was 0%.

Based on available literature, UAE represents a safe and effective uterus-preserving minimally invasive treatment for selected patients with symptomatic adenomyosis; it represents a step on the treatment pathway before hysterectomy, and women should have access to consult with interventional radiologists when making any treatment decision, in order to achieve a personalized treatment plan.