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Cochin AP-HP

Adenomyosis — Uterine Artery Embolization

Interventional Radiology · Cochin Hospital AP-HP · Paris

️ ri.cch@aphp.fr +33 1 58 41 46 12
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🌸 Gynaecology · Non-surgical

Adenomyosis Embolization — Paris, Cochin AP-HP

Uterine artery embolization · Uterus preserved · Heavy periods · Pelvic pain · Same-day discharge

📖 What is adenomyosis?

Adenomyosis is a benign condition in which the endometrial tissue (inner lining of the uterus) grows into the muscular wall of the uterus (myometrium). It causes heavy, painful periods (menorrhagia and dysmenorrhoea), pelvic pain, and a bulky, tender uterus. It often coexists with uterine fibroids and/or endometriosis.

Uterine artery embolization (UAE) reduces blood flow to the affected myometrium, leading to shrinkage of the adenomyotic tissue and relief of symptoms in 70–80% of patients. The uterus is fully preserved — unlike hysterectomy. Fully covered by French national health insurance at Cochin AP-HP — no patient fees.

🎯 Who is suitable?

  • Heavy menstrual bleeding (menorrhagia) significantly affecting quality of life
  • Chronic pelvic pain or severe dysmenorrhoea related to adenomyosis
  • Bulky uterus confirmed on MRI or ultrasound
  • Patient wishing to preserve her uterus and avoid surgery
  • Contraindication to or refusal of hysterectomy or endometrial ablation
  • Adenomyosis associated with uterine fibroids (both treated in a single procedure)

🔧 The procedure

1
Pre-procedure MRI

Pelvic MRI to confirm adenomyosis, assess extent, and plan embolization.

2
Admission — Day procedure unit

Patient arrives in the morning. IV cannula placed. Local anaesthesia and conscious sedation.

3
Femoral artery puncture (right groin)

Percutaneous access to both uterine arteries via the right femoral artery using standard Seldinger technique.

4
Bilateral uterine artery embolization

Selective catheterisation and embolization of both uterine arteries with calibrated microspheres, reducing blood supply to adenomyotic tissue.

5
Recovery and discharge

4–6 hours observation. Same-day discharge with oral analgesia. Pain managed at home with NSAIDs and paracetamol.

6
Follow-up MRI at 3–6 months

Reduction in uterine volume and symptom assessment. Menstrual flow typically improves from the first post-procedure cycle.

📊 Results

70–80%
Improvement in heavy bleeding
Same day
Discharge from hospital
Uterus
Fully preserved
Criterion UAE (Cochin) Hysterectomy
AnaesthesiaLocal + sedationGeneral
Uterus preservedYes ✓No
Hospital stayDay case ✓3–5 days
Recovery7–10 days4–6 weeks
Success rate70–80%100% (no uterus)
Covered by insurance100% ✓100% ✓

❓ FAQs

Yes. If adenomyosis and uterine fibroids coexist, both are treated in the same UAE procedure, as both are supplied by the uterine arteries.
Most patients (70–80%) experience a significant reduction in menstrual flow within 1–3 months. Complete resolution is more common in fibroid-dominant disease than in pure adenomyosis.
UAE is not the preferred option for women wishing to conceive, as it may affect uterine perfusion. Discuss fertility-sparing alternatives with your gynaecologist before deciding.
Correct. Cochin Hospital AP-HP is a French public hospital. All procedures are covered by the French national health insurance (equivalent to the NHS). No out-of-pocket expenses.

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