Comparison of Clinical and Imaging Outcomes of Two Uterine Artery Embolization (UAE) Protocols Using 100-700 µm Microspheres Versus 300-700 µm Microspheres in Patients with Adenomyosis

A retrospective chart review was conducted on patients with pure adenomyosis or adenomyosis-dominant disease with fibroids who underwent UAE at a single institution. The study included 19 patients, with approximately 70 patients being added for further analysis by March 2025. 10 patients received UAE with Protocol A using 300-500 µm and 500-700 µm microspheres, while 9 Protocol B patients also received 100-300 µm microspheres. Efficacy outcomes were evaluated six months after UAE based on clinical symptom relief including improvement in bleeding, bulk symptoms, and pelvic pain. Efficacy was also measured with MRI findings of junctional zone thickness reduction, uterine volume reduction, and percent of necrosis.

Results:

Protocol A patients experienced significant improvement in bleeding compared to those in Protocol B (p=0.057). Both groups demonstrated similar rates of pelvic pain improvement, with about half reporting relief and the other half experiencing no change. There was no significant difference between the groups in bulk symptom improvement. MRI findings revealed Protocol A more effective than Protocol B in reducing the junctional zone thickness and uterine volume (p=0.045 and p=0.042, respectively). Necrosis rates did not differ significantly between the two protocols.

Conclusion:

Protocol A demonstrated statistically significant superior outcomes in reducing junctional zone thickness and uterine volume to Protocol B. Clinically, Protocol A patients experienced greater improvement in bleeding, though there was no significant differences in pelvic pain or bulk symptoms between the two groups. Further studies with larger patient populations are warranted to confirm these findings and determine if any advantages exist for either protocol.