Prof Saim Yılmaz, MD
"Embolization is very effective also in adenomyosis"
What is Adenomyosis?
Adenomyosis is the condition where the "endometrium", which forms the inner surface of the uterus and causes menstrual bleeding, infiltrates into the muscle layer of the uterus. Adenomyosis tissue can be in one region of the uterus (focal), or it can spread (diffuse) in many regions or throughout the uterus. Since these patients also bleed into the uterine muscle layer during menstruation, they typically experience severe pain during menstruation. Adenomyosis is a disease that can be confused with fibroids due to the similarity of clinical and imaging findings, but can also coexists with fibroids in the same patient.
How is it diagnosed?
Adenomyosis is most commonly seen in women aged 30-50 years and in women who have given birth. It is believed that the disease develops due to the high level of estrogen hormone. For this reason, it is often seen together with diseases such as estrogen-related fibroids and endometriosis (existence of endometrial layer also in extra-uterine organs, most often in ovaries). Although adenomyosis is a common disease, it is difficult to diagnose. The most important step is to suspect and investigate the disease. The most important clinical findings in adenomyosis are increased menstrual bleeding and painful menstruation. There may also be infertility and pain during sexual intercourse. However, these complaints can also be seen in fibroids and endometriosis.
If adenomyosis does not cause any discomfort to the patient, no treatment is required. However, since patients often have disturbing complaints, treatment is generally necessary. Hormone spirals and other hormonal drugs are used especially to reduce bleeding complaints, but drug treatment is generally not considered very successful. Since adenomyosis cannot be separated from normal uterine tissue with sharp boundaries, it is usually not possible to completely remove this tissue as in uterine fibroid surgery. Therefore, if surgical treatment is to be performed in adenomyosis, removal of the entire uterus (hysterectomy) is preferred. However, since hysterectomy was not desired by many patients, alternative treatment methods were developed. Among them, HIFU and percutaneous ablation have been applied in focal adenomyosis and a certain degree of success has been achieved. However, among the alternative methods, the most successful one in eliminating patient complaints is embolization therapy, which has been successfully applied for years in the treatment of uterine fibroids.
Embolization is the insertion of a very thin catheter into the uterine arteries with an angio procedure from the groin under local anesthesia and the occlusion of the uterine vessels by injecting very small particles from this catheter. This method, which is described in detail on our website, is a procedure that mainly provides non-surgical treatment for uterine fibroids and has been used successfully for more than 20 years in the world. It was discovered by chance that this method was also useful in the treatment of adenomyosis; After embolization for uterine fibroids in patients with adenomyosis in addition to uterine fibroids, it was observed that the adenomyosis tissue also shrank and their complaints disappeared, and then the embolization method was successfully used in patients with only adenomyosis. Today, there are thousands of adenomyosis patients who have been treated with the embolization method. In the literature, in a study conducted in 2011, more than 500 patients with adenomyosis treated with embolization were examined and it was found that the embolization method completely eliminated or greatly reduced the complaints related to adenomyosis in more than 75% of these patients, and this improvement continued for years.
Video: How we do embolization from A to Z, Prof Dr Saim Yılmaz
In our center also, the embolization method, which we have been using for uterine fibroids for years, has also been used in patients with adenomyosis with or without fibroids, and we have observed that the complaints of adenomyosis have disappeared or significantly decreased in the vast majority of our patients.