Clinical research of uterine arterial embolization combined with levonorgestrel releasing intrauterine system in the treatment of adenomyosis

Objective To investigate the clinical effect of uterine artery embolization combined with Levonorgestrel(LNG)-releasing intrauterine system in the treatment of adenomyosis,and explore a conservative effective therapy of uterine adenomyosis. Methods Total 78 inpatients with histologically confirmed adenomyosis in hospital undergoing percutaneous common femoral artery(CFA) puncture for uterine artery embolization with the 4F Cobra catheter 3-7 days after their menstruation cycle.And the LNG-releasing intrauterine system was placed in two months after operation.The degree of dysmenorrhea,volume of menstrual flow,the size of the uterus and changes of the endometrial thickness by pelvic ultrasound,the level of serum CA125,and the function of ovary were evaluated on the regular follow-up evaluation. Results In 3,9 and 12 months after uterine artery embolization combined with LNG-releasing intrauterine system therapy,the dysmenorrhea score,PBAC score,endometrial thickness,CA125 level and the size of the uterus were improved as compared with those before the treatment,the difference was statistically significant(P<0.05).The volume of uterine after the placement of Mirena was not changed obviously,the difference was no significant(P>0.05).After the treatment,a small amount of vaginal bleeding occurred in a few patients,but the ring did not move down or fall off in any cases.The serum sex hormone levels(LH,E2 and FSH) before the uterine artery embolization,2 months after the surgery,and 3 and 12 months after LNG-releasing intrauterine system placement did not changed obviously,there were no significant differences(P>0.05),which did not show the reduced ovarian reserve function. Conclusion Uterine artery embolization combined with LNG-releasing intrauterine system for adenomyosis has the advantages of small trauma,high safety,not affecting ovarian function.