Adenomyosis Embolization or Hysterectomy: Four QUESTA Checks

If embolization is offered for adenomyosis, name the symptom you most want treatment to change and whether keeping your uterus matters to you. Then ask what the comparison with hysterectomy can establish about that goal.

UAE aims to shrink adenomyosis by blocking its blood supply.¹

Treatment choice shaped the study

QUESTA’s 2025 report included 101 women: 50 underwent uterine artery embolization, UAE, and 51 hysterectomy. The intended randomized trial became a patient-choice cohort because recruitment was slow. Participants had MRI-confirmed symptomatic adenomyosis and did not wish to conceive.²

That selection matters when applying the findings to someone hoping for a future pregnancy.²

Better scores did not establish equal outcomes

Both groups’ quality-of-life scores improved at one year, on 0–100 scales. It could not establish that UAE’s quality-of-life scores were no more than five points worse than hysterectomy’s. The main per-protocol analysis excluded six UAE patients who subsequently had hysterectomies. An analysis retaining them favored hysterectomy on SF-12 physical and mental scores.²

Ask whether a quoted outcome includes people who needed another treatment. A result among those who continued with the initial procedure answers a narrower question.

Satisfaction and another procedure are separate outcomes

At one year, 29/40 UAE respondents versus 41/43 hysterectomy respondents were satisfied. Boston Scientific and Merit Medical funded the study.²

A 2023 review’s analysis of seven UAE series with follow-up of at least 24 months estimated 16.8% underwent another procedure, with a 95% confidence interval of 11.5–22.2%. The studies were observational and follow-up lengths differed. This is not a precise personal two-year probability. Treatment with medicines alone did not count as reintervention.³

Ask the team to explain what “success” includes: symptom improvement, satisfaction, keeping the uterus or avoiding a further procedure. Request the timeframe and the number of people followed, along with the percentage.

The consent discussion still needs fertility and recurrence

NICE’s¹ UK procedural guidance, originally issued in 2013 and now numbered HTG324, says UAE can be used with normal consent, governance and audit arrangements. It specifically calls for explaining that symptoms may not improve, may return and may require further procedures. Effects on fertility remain uncertain.¹

It recommends selection by a team including a gynecologist and an interventional radiologist.¹

Before deciding, ask what each team thinks the scan shows, which earlier treatments remain relevant, what recovery would involve and how persistent or returning symptoms would be managed. Put any wish for pregnancy into that conversation explicitly.

Bring the symptom history and scan report

“Adenomyosis and Fibroid Pain” in Period, Handled explains why adenomyosis, fibroids and endometriosis can require separate consideration even when symptoms overlap. Bring your scan report, treatment history and dated pain and bleeding notes. Our adenomyosis assessment guide helps organize those details.