If you’ve been diagnosed with uterine fibroids and your doctor has also mentioned adenomyosis—or if you’ve been treated for fibroids but your symptoms haven’t fully resolved—you may be dealing with two conditions at once. It’s more common than many women realize, and it changes the treatment conversation in important ways.
Adenomyosis and fibroids can coexist in the same uterus, produce overlapping symptoms, and be difficult to distinguish from each other without advanced imaging. The good news: uterine fibroid embolization (UFE)—the same minimally invasive procedure that treats fibroids—can also treat adenomyosis. And when both conditions are present together, the response to UFE may actually be better than for either condition alone.
What Is Adenomyosis?
While fibroids are distinct growths—balls of smooth muscle that develop in or on the uterus—adenomyosis is a diffuse condition. It occurs when the endometrium (the tissue that normally lines the inside of the uterus) grows into the myometrium (the muscular wall of the uterus). This displaced tissue continues to function normally—thickening, breaking down, and bleeding with each menstrual cycle—but because it’s trapped within the muscle, it causes the uterus to become enlarged, tender, and often quite painful.
Adenomyosis typically produces heavy, prolonged menstrual bleeding (often with clots), severe menstrual cramps (dysmenorrhea) that may worsen with age, chronic pelvic pain and pressure, a uterus that feels enlarged or boggy on examination, and painful intercourse (dyspareunia) in some women.
If this sounds similar to fibroid symptoms, that’s because it is. The two conditions share significant symptom overlap, which is one reason adenomyosis is frequently underdiagnosed. Many women are told they have “just fibroids” when adenomyosis is also contributing to their symptoms.
How Often Do They Occur Together?
The co-occurrence of fibroids and adenomyosis is well documented. Studies estimate that 35–55% of women with fibroids also have adenomyosis, though the true rate may be higher since adenomyosis is often only definitively diagnosed after hysterectomy when the uterine tissue can be examined under a microscope.
MRI has become the gold standard for pre-operative diagnosis. Unlike ultrasound, MRI can distinguish between fibroid tissue and adenomyotic tissue with high accuracy, allowing physicians to identify both conditions and plan treatment accordingly. At SACMD, we recommend MRI before UFE for this reason—not just to map the fibroids, but to evaluate for adenomyosis that might be contributing to symptoms.
Why This Dual Diagnosis Matters for Treatment
When both conditions are present, the treatment plan must address both—otherwise symptoms may persist even after successful fibroid treatment. This is one explanation for cases where a woman has “successful” fibroid treatment (whether UFE or myomectomy) but continues to experience heavy bleeding and pain. The fibroids may have been addressed, but the adenomyosis was not.
Hysterectomy treats both conditions definitively, since it removes the entire uterus. But for women who want to preserve their uterus—for fertility, for personal reasons, or simply because they’d prefer to avoid major surgery—UFE offers a compelling alternative that can address both fibroids and adenomyosis in a single procedure.
How UFE Treats Both Conditions
The principle is the same for both conditions: by blocking the uterine arteries that supply blood to the uterus, UFE reduces blood flow to both the fibroids and the adenomyotic tissue. Without their blood supply, fibroids shrink and die. Adenomyotic tissue is similarly affected, leading to a reduction in uterine enlargement and an improvement in symptoms.
There is one technical difference worth noting. When treating adenomyosis with UAE, interventional radiologists may use smaller particle sizes than those typically used for fibroid embolization alone. This allows more thorough penetration into the diffuse adenomyotic tissue within the uterine wall. Your interventional radiologist will adjust the technique based on your specific imaging findings.
The success rates are encouraging. Published data shows that approximately 83% of women with pure adenomyosis experience significant symptom improvement after uterine artery embolization. When both adenomyosis and fibroids are present together, the improvement rate rises to approximately 93%. More recent long-term studies suggest an 85.4% probability of sustained improvement for adenomyosis patients treated with UAE.
Who Is a Candidate?
UFE for concurrent adenomyosis and fibroids is appropriate for women with symptomatic disease (heavy bleeding, pain, pressure) who have failed or do not want hormonal therapy, women who want a uterus-preserving treatment, women who are not ideal surgical candidates or who prefer to avoid hysterectomy, and women with an MRI confirming both conditions.
UFE may be less appropriate for women with very extensive adenomyosis involving the entire uterine wall, though even in these cases, published data shows meaningful symptom improvement in the majority of patients. A thorough pre-procedural MRI evaluation helps set realistic expectations.
The Bottom Line
If you have fibroids and your symptoms haven’t fully responded to treatment—or if your doctor has mentioned adenomyosis—ask about UFE. It’s the only non-surgical procedure that can treat both conditions simultaneously, with a same-day outpatient recovery and insurance coverage under virtually all plans.
Frequently Asked Questions
Q: Can UFE treat adenomyosis?
A: Yes. Studies show approximately 83% of women with adenomyosis experience symptom improvement after uterine artery embolization, and the improvement rate rises to about 93% when both adenomyosis and fibroids are present.
Q: How is adenomyosis different from fibroids?
A: Fibroids are distinct growths of muscle tissue within or on the uterus. Adenomyosis occurs when the tissue that normally lines the uterus (endometrium) grows into the muscular wall itself, causing the uterus to become enlarged and tender.
Q: Do I need an MRI before UFE if I have adenomyosis?
A: Yes. MRI is the gold standard for identifying adenomyosis and mapping fibroids, and should be performed before UFE to guide treatment planning.
The key is proper imaging. An MRI before treatment ensures that both conditions are identified and that your treatment plan is designed accordingly.
Schedule a consultation: Call (240) 427-1630 or visit www.sacmd.com
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Individual results vary.
References:
- UCLA Health. Uterine Artery Embolization — Fibroids and Adenomyosis. uclahealth.org.
- PMC. Management of uterine adenomyosis: current trends and UAE as a potential alternative to hysterectomy. 2019.
- PMC. An update on UAE for uterine leiomyomata and adenomyosis of the uterus. 2023.
- Weill Cornell Medicine. Uterine Artery Embolization — Fibroid and Adenomyosis Program.
