Uterine Artery Embolization for Adenomyosis

Uterine artery embolization (UAE), the same procedure used for fibroids, can also relieve symptoms of adenomyosis for many women. A 2017 review of the published studies found that symptoms improved in 83.1% of patients (872 of 1,049). The strongest comparison with surgery so far, the Dutch QUESTA study published in 2025, found that both embolization and hysterectomy improved quality of life after one year, but hysterectomy relieved pain more and left more women satisfied (95% vs 73%). Embolization is a reasonable option if you want to keep your uterus and accept that relief is less certain than with hysterectomy.

Adenomyosis in brief

In adenomyosis, tissue like the lining of the uterus grows into the muscle wall of the uterus. The uterus can become enlarged and tender, and periods are often heavy and painful. It can occur on its own or alongside fibroids, and the two can cause similar symptoms. That is why imaging matters. MRI can show a thickened inner muscle layer (the junctional zone) that points to adenomyosis rather than, or in addition to, fibroids. Our guide to adenomyosis vs fibroids explains how doctors tell them apart.

In the main studies below, embolization was offered to women whose adenomyosis had not responded to other treatment and who were otherwise facing a hysterectomy. That is the situation in which the evidence applies most directly.

How embolization is used for adenomyosis

The procedure is the same as uterine fibroid embolization (UFE): a thin catheter is guided into the uterine arteries and small particles are released to reduce blood flow to the affected tissue. With fibroids, the targets are distinct lumps. With adenomyosis, the abnormal tissue is spread through the muscle wall, so the aim is to reduce blood flow to the affected muscle. In the 2017 review, uterine volume had shrunk in all patients by 3 months.

What the research shows

Why QUESTA matters, and its limits

QUESTA was planned as a randomized trial but was converted into a cohort study, in which women chose their own treatment. That makes the comparison less clean, because women who choose embolization may differ from those who choose surgery. The researchers adjusted for the differences they measured. Their conclusion was balanced: embolization is "a valid less-invasive alternative to hysterectomy, with preservation of the uterus," while "hysterectomy remains the treatment of choice for patients seeking a definite solution." Two of the authors received research funding from companies that make embolization materials, though the study was run by the investigators.

This article is part of our Fibroid Treatment Guide.

Does it matter if you also have fibroids?

The evidence is mixed. In the 2017 review, women who had both adenomyosis and fibroids reported somewhat more long-term symptom relief (11.4% more) than women with adenomyosis alone. In Smeets' smaller long-term study, having fibroids as well made no difference to the outcome. What did predict a later hysterectomy in that study was a thicker junctional zone on the MRI before treatment. Your doctor can use your MRI to give you a more personal sense of how likely embolization is to help.

Who might consider embolization for adenomyosis

• Women whose symptoms have not improved enough with other treatments
• Women who want to keep the uterus, or who want to avoid a major operation
• Women who are not pregnant and do not plan pregnancy soon (pregnancy data after embolization are limited, as they are for fibroids)
• Women who understand that relief is likely but less certain than with hysterectomy, and that some will later need surgery

The general checks before any uterine embolization still apply: a gynecologic evaluation, a contrast MRI, and ruling out pregnancy, cancer and active infection. See am I a candidate for UFE? for that checklist. If you are mainly weighing embolization against surgery, UFE vs hysterectomy covers the fibroid trials, which have longer follow-up than the adenomyosis studies.

What these numbers mean for you

It helps to turn the percentages around. If 83.1% of women improved in the 2017 review, roughly 1 in 6 did not improve enough to count. In QUESTA, 73% were satisfied with embolization a year later, which means about 1 in 4 were not. In Smeets' long-term study, nearly 1 in 5 women went on to have a hysterectomy within about 5 years. These are averages from studies, not predictions for one person, but they give a fair sense of the odds.

Embolization should also not be done in certain situations. The CIRSE 2015 guideline lists pregnancy, cancer of the uterus or ovaries, and active infection of the uterus as reasons not to perform uterine artery embolization. Evidence about pregnancy after embolization for adenomyosis is very limited, so if you hope to have children, discuss that before choosing any procedure.

Recovery, side effects and insurance

Recovery

Recovery after embolization for adenomyosis is generally described in the same terms as after UFE: cramping and pain in the first days, sometimes with low fever, nausea and tiredness, then a gradual return to normal activity. Call your doctor for pain that medicine does not control, a fever above 101°F, or persistent vomiting. The adenomyosis studies above did not report recovery times separately, so ask your doctor what to expect in your case.

Insurance

Insurance coverage for embolization is usually written around fibroids. Coverage for adenomyosis alone may be reviewed differently, so check with your plan before scheduling, ask whether prior authorization is needed, and ask the office to confirm benefits in writing. If you have both fibroids and adenomyosis on your MRI, make sure the request describes both. For how fibroid treatment coverage works more broadly, see our fibroid treatment guide.

Questions to ask

• Does my MRI show adenomyosis, fibroids, or both?
• How thick is my junctional zone, and what does that mean for my chances?
• How likely am I to need a hysterectomy later?
• Are there other treatments I should try first?
• Will my insurance treat this as a fibroid procedure or review it separately?

Frequently Asked Questions

Is uterine artery embolization effective for adenomyosis?

For many women, yes. A 2017 meta-analysis found symptom improvement in 83.1% of patients, and a long-term study found that 33 of 40 women kept their uterus after about 5 years.

Is embolization as good as hysterectomy for adenomyosis?

Not proven. In the 2025 QUESTA study of 101 women, both improved quality of life at 1 year, but hysterectomy relieved pain more and 95% were satisfied, compared with 73% after embolization.

Can adenomyosis come back after embolization?

Symptoms can persist or return. In one study of 40 women followed for about 5 years, 18% later had a hysterectomy and 4 of the 33 who kept their uterus still had substantial symptoms.

How do I know whether I have adenomyosis or fibroids?

MRI is the most helpful test, because it can show a thickened junctional zone typical of adenomyosis as well as distinct fibroids. Many women have both.

Keep Reading

• Uterine Fibroid Embolization (UFE) in New York City
• Adenomyosis vs Fibroids: Symptoms, Imaging and Why the Difference Matters
• Am I a Candidate for UFE? A Practical Checklist
• UFE vs Hysterectomy: What 10 Years of Trial Data Show
• Fibroids or Pelvic Congestion Syndrome? How to Tell Them Apart
• Fibroid Treatment Guide: every option, compared

Sources

1. de Bruijn et al., J Vasc Interv Radiol, 2017 — UAE for adenomyosis: systematic review and meta-analysis
2. Trommelen et al., Acta Obstet Gynecol Scand, 2025 — QUESTA study: quality of life 1 year after UAE vs hysterectomy for adenomyosis (101 women)
3. Smeets et al., Cardiovasc Intervent Radiol, 2012 — long-term follow-up of UAE for adenomyosis (40 women)
4. ACOG patient FAQ, Uterine Artery Embolization (last reviewed May 2026)
5. van Overhagen & Reekers, Cardiovasc Intervent Radiol, 2015 — CIRSE Standards of Practice: uterine artery embolization for symptomatic leiomyomata

Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.

Living with heavy periods, pelvic pressure or other fibroid symptoms? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether uterine fibroid embolization is right for you. Call (212) 362-3470 or request a UFE consultation online.