For women in San Antonio whose period pain was never “just a bad period”
Adenomyosis causes heavy bleeding and labor-like cramps — and too often, the only fix offered is a hysterectomy. Uterine artery embolization (UAE) is a non-surgical, uterus-sparing alternative that treats the tissue causing the problem. Covered by most insurance plans, including Medicare and Medicaid — and we’re in-network with most plans. No referral needed for your initial consultation.
Covered by most insurance, including Medicare & Medicaid No referral needed for your initial consultation
Every month, pain that feels like labor. Not “bad cramps” — the kind of pain that has you pacing the floor at 3 a.m., planning your life around one week you dread.
Maybe you’ve been told it’s just heavy periods. Maybe you tried the hormonal IUD that was supposed to fix everything, or the pills, or the shots that came with their own misery. Maybe an ultrasound found “nothing.”
And maybe somebody finally said the word — adenomyosis — right before saying the other word: hysterectomy.
Your pain has a real, physical cause. It has a name. And a hysterectomy is not your only option.
What adenomyosis actually is
Adenomyosis happens when the tissue that lines your uterus grows into the muscle wall of the uterus itself. Every month, that misplaced tissue does what uterine lining does — it swells and bleeds — but inside the muscle, with nowhere to go. The uterus becomes enlarged, tender, and inflamed.
The result: crushing cramps, heavy bleeding, and a deep, dragging pain that hormonal treatments often can’t fully quiet.
Fibroids vs. adenomyosis
Fibroids vs. adenomyosis — what every woman needs to know Watch on YouTube →
Two conditions constantly mistaken for each other — and nearly half of women with adenomyosis have both. Our team walks through how they differ, why ultrasound so often confuses them, and what that means for the treatment you get offered.
How common it is
One source says 1%. Another says 70%. The estimates disagree because they count different women with different tools — for decades the only way to diagnose adenomyosis was to examine a uterus after it had been removed, so the only women counted were women already sick enough to have had a hysterectomy.
The largest analysis to date pooled nearly 200 million women across 127 studies. Here is what it found, depending on who is being counted:⁶
That last line is the one that matters if you’re reading this page. Nearly half of women worked up for exactly your symptoms turn out to have adenomyosis — and about 48% of women with adenomyosis also have fibroids, which is why the two get confused and why results are strongest when both are treated together.⁶
Honestly, nobody fully knows. What is well established:
Note what is not on that list: anything you did. Adenomyosis is not caused by your diet, your weight, your stress, or waiting to have children.
What it does to you
Heavy or prolonged periods. Passing large clots. Bleeding between periods. Anemia — and the exhaustion, breathlessness and brain fog that come with it.
Cramping many women describe as labor-like. Pain that starts before the bleeding and outlasts it. Chronic pelvic pain outside your period. Painful intercourse — deep pain during or after sex, which many women never think to mention and we’ll ask about directly.
Cramps that have got worse year over year — the pattern that most distinguishes adenomyosis from ordinary period pain.
A uterus that feels enlarged, tender, heavy. Bloating; clothes that don’t fit during your period. Needing to urinate more often. Painful bowel movements during your period.
Days lost every month — work, plans, sleep. Planning your calendar around one week you dread. Difficulty conceiving.
Some women have adenomyosis and no symptoms at all. That is real too — and it does not need treating.
Getting a real diagnosis
It usually starts with an exam. An enlarged, globular, tender uterus is often the first clue — and the reason imaging gets ordered at all.
Then a transvaginal ultrasound, which is almost always the first test you’ll be given: painless, no radiation, widely available. Radiologists work from a checklist of features, and the most telling one is a pattern called echogenic subendometrial lines and buds. No single sign settles it.
The problem is what ultrasound misses. Pooled across studies, transvaginal ultrasound finds adenomyosis in roughly seven out of ten women who actually have it — so somewhere around one in four is missed. That isn’t a rare failure. It’s a known limit of the test.⁶
If you were told your ultrasound was normal and your symptoms haven’t changed, that is a reason to ask for an MRI — not a reason to accept that nothing is wrong.
MRI is the more reliable test, and it’s what we use to plan. It measures the junctional zone — the border between lining and muscle, and often the earliest sign there is. It separates adenomyosis from fibroids, which matters because nearly half of women have both. And it gives us the map we need before an embolization. Short of taking tissue, it is the most sensitive test available.⁶
Tissue is the one thing more definitive — and it’s also the reason adenomyosis went unrecognized for so long. For decades the diagnosis was made by a pathologist examining a uterus after it had been removed. Getting the answer should not require losing the organ. That’s the whole case for imaging it properly.
Before anyone recommends a treatment, insist on four answers
It changes which options are even possible.
Nearly half of women with adenomyosis do — and it changes the plan, usually in your favor.
About one in five do. It’s a different condition with its own treatments, and treating one won’t fix the other.
Not “is my hemoglobin normal.” Ask for ferritin.
Being offered a hysterectomy for a symptom is not a plan. If heavy bleeding or pain is what sent you to the doctor and nobody has imaged you properly, then nobody yet knows what is causing it — and removing an entire organ to treat a symptom whose cause was never identified is not a treatment plan. That is the whole reason we start with an MRI: find out exactly what is driving your symptoms, and then put the real options on the table. If you need one and don’t have one, we’ll order it.
Diagnostic accuracy figures are pooled across published studies comparing transvaginal ultrasound and MRI against a tissue reference standard; sensitivity varies with the pattern of disease, the equipment, and the experience of the person reading the scan. Full citations appear in our adenomyosis patient guide, free below.
Your real options
The pill, the hormonal IUD, injections. These can genuinely reduce bleeding and pain for some women. But be clear about what they do: they mask the symptoms. They don’t treat the tissue causing them — and for many women with adenomyosis, they simply aren’t enough.
Removing the uterus removes the disease. It’s definitive, and for some women it’s the right choice. It’s also major surgery, weeks of recovery, and final.
When adenomyosis is focal — concentrated in one spot instead of spread through the wall — it can form a distinct mass called an adenomyoma. It behaves much like a fibroid, and it’s frequently mistaken for one on ultrasound. Because it sits in one place, a surgeon can sometimes cut it out and repair the uterus.
The limits are worth knowing. It’s an option for focal disease only — not for the diffuse pattern, which is the more common one and the harder one to cut out. It doesn’t treat adenomyosis elsewhere in the wall, which imaging often finds alongside it. And it is still surgery: an incision, an anesthetic, and a real recovery.
The third option — the one most women are never told about. Through a pinhole in the groin, an interventional radiologist blocks the small arteries feeding the diseased tissue in the uterine wall. Starved of blood, that tissue shrinks and scars down — while your uterus stays where it is. It is the only non-surgical treatment that addresses the tissue itself rather than masking the symptoms.
And it treats an adenomyoma too. A focal adenomyoma depends on its blood supply exactly the way a fibroid does — so we treat it the same way we treat fibroids, without cutting anything out. It also treats diffuse disease, and the fibroids that nearly half of women have alongside it, in the same session.
What to know first
In our practice, more than 85% of women feel substantial to complete relief of their symptoms — in line with the published long-term results below.¹
How long the improvement lasts generally depends on your age when we treat it. Adenomyosis is estrogen-dependent, so the closer you are to menopause, the lower the risk of recurrence. In our experience, only about 15% of patients see symptoms return over ten years — a number we personalize at your consultation, because your age changes it. And if symptoms do return, re-treatment can be considered down the road.
For most patients, that’s an acceptable trade. This is a uterus-sparing, in-office treatment that effectively controls symptoms — weighed against a hysterectomy, which is major surgery, weeks of recovery, and final. We’ll never promise permanence — and if anyone does, be careful.
The published evidence
Start with the longest follow-up published. Researchers in Australia tracked women who had UAE for adenomyosis and followed them for a mean of 52 months — more than four years, and out to nearly ten in some cases. That study is the backbone of this section, because durability is the question every woman asks and the one most papers can’t answer.¹
9 in 10
women — 82 of 91 — were still “happy” or “very happy” with the result at a mean of 52 months, with no return of symptoms and no further procedure.¹
Severe → mild
symptom scores fell from 58.9 to 20.0 on the standard measure, and quality-of-life scores more than doubled — 40.3 to 86.3.¹
83%
of 1,049 women improved after embolization in the largest pooled analysis of the treatment — the wider evidence base behind that single study.⁵
The papers this page is built on.
The four-year durability study, the European trial that put embolization head-to-head with hysterectomy, and the reviews behind them. Adenomyosis research is younger and thinner than the fibroid literature — there is still no large randomized trial — and we would rather show you the actual shelf than imply it’s taller than it is.
The five-year picture, plainly: in a separate series of 252 women followed for five years, period pain was still improved in 70% and heavy bleeding in 69% — durable for most, not for everyone.⁶
The head-to-head with hysterectomy: in 2025 a European study (QUESTA) published one-year results for 101 women who chose either UAE or hysterectomy. Quality of life improved significantly after both, with comparable one-year scores — and 44 of the 50 women who chose UAE kept their uterus. The authors’ conclusion: UAE “is a valid less-invasive alternative to hysterectomy, with preservation of the uterus.”²
A fear worth putting to rest: in the durability study, UAE did not appear to bring menopause forward.¹
What we won’t claim: that UAE is a cure for adenomyosis. But it is the only reliable uterine-sparing treatment for it.
Sources: 1. Ma, Brown & Liang, Aust N Z J Obstet Gynaecol 2021 — long-term durability study; 91 of 104 women followed a mean of 52 months (median 50, range 5–117): 82/91 (90%) remained happy or very happy with no recurrence and no further intervention; UFS-QOL symptom severity 58.9→20.0, quality of life 40.3→86.3; the 9 who did not maintain success failed at a mean of 31 months. 2. Trommelen et al. (QUESTA study), Acta Obstet Gynecol Scand 2025;104(8):1558–74 — 101 women (50 UAE, 51 hysterectomy), prospective comparative design; 44/50 UAE patients retained the uterus at one year. 5. de Bruijn et al., J Vasc Interv Radiol 2017 — systematic review and meta-analysis of UAE for adenomyosis: symptom improvement in 83.1% (872/1,049 patients). 6. Zhou et al., PLoS ONE 2016;11(11):e0165610 — 252 women, 195 (77.4%) followed to five years: dysmenorrhea improved in 74.0% at 12 months and 70.4% at 5 years; menorrhagia in 70.9% and 68.8%. Sources 5–6 abstract- and full-text-verified respectively — confirm full texts before any print or ad use.
What the procedure is like
UAE is done in our own IR suite, in our office — not a hospital. The procedure itself doesn’t hurt; you’re sedated and comfortable, and you go home the same day, usually after about an hour of recovery.
The first night is the hard part: as the treated tissue reacts, the cramping is very real — for most women, about the first 18 hours. We counsel every woman about this up front, you go home with real pain medication and a plan, and we call you the next morning. In our practice, most patients are off their narcotic pain medication by the next day. And every patient goes home with the on-call doctor’s cell phone number, in case any questions or concerns come up.
UAE · No surgery
“Before you get a hysterectomy… stop!” Watch on YouTube →
A full walk-through of adenomyosis: the symptoms, the risk factors, and why the condition is still so poorly diagnosed in medicine — then, in detail, how uterine artery embolization treats it without a hysterectomy.
Candidacy
We turn away patients who aren’t candidates for what we do. Routinely.
Your care team
Uterine artery embolization at ARV Centers is performed by Board Certified Vascular and Interventional Radiologists — and we’re glad to coordinate with your OB/GYN before and after.
After your procedure
When you go home, you take the on-call doctor’s cell phone number with you. Not an answering service — the doctor.
And you don’t have to wonder whether to bother us: we call you the next day to check in. Every patient, every procedure.
Before you leave, you’ll get this card
Your procedure:
On-call doctor:
Cell phone: written by hand, before you walk out
Call me if anything worries you.
Straight answers
Same reason as with fibroids: UAE is performed by interventional radiologists — a different specialty from your OB/GYN, with a different referral network. Most women find it by refusing the first answer and looking for themselves.
UAE for adenomyosis has years of published follow-up — including the four-plus-year study above — and uses the same FDA-cleared technique and materials as fibroid embolization, which ACOG recommends at its highest evidence level for fibroids.¹ And in 2025, the European QUESTA study published its one-year results comparing the two paths directly: among 101 women who chose either UAE or hysterectomy, quality of life improved significantly after both, with comparable one-year scores — and 44 of the 50 women who chose UAE kept their uterus through the first year.² The authors’ conclusion: UAE is a valid, less-invasive alternative that preserves the uterus. The trade, plainly: women who chose hysterectomy reported more pain relief and higher satisfaction — removing the disease outright does that. That’s exactly the choice we’ll walk through with you.
In the longest follow-up study, UAE did not appear to bring menopause forward.¹
Adenomyosis is a known cause of infertility. If you’ve been having trouble getting pregnant and you have adenomyosis, this may well be the reason — and it’s worth saying out loud, because a lot of women are worked up for everything else first.
A hysterectomy obviously does nothing for fertility. Since embolization is the only non-surgical treatment that reduces the adenomyotic tissue itself — rather than masking symptoms — it is a widely accepted way to treat the disease while keeping the uterus, with the aim of improving your chances. Fertility is its own conversation, and we’ll have it with you specifically at your consultation — your age, your imaging, and your timeline all matter.
Yes — insurance typically covers embolization for adenomyosis the same way it covers it for fibroids: most plans, including Medicare and Medicaid, and we’re in-network with most plans. We do a complimentary benefits check before any procedure. No surprises.
Not for your initial consultation — call us directly. If your plan requires a referral or prior authorization for treatment itself, we’ll identify that during the complimentary benefits check and help you get it.
Free patient guide
Our free adenomyosis guide explains what adenomyosis is, why it takes so many women years to get a name for it, and every treatment option — from the hormonal IUD to hysterectomy, including the ones we don’t perform — plus the questions worth asking any doctor, including us. Written by our physicians. No appointment required, and no follow-up phone call unless you ask for one.
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Bring your imaging if you have it. You’ll get a straight answer about whether we can help. Call us directly, or send this form and we’ll call you to schedule. We do a complimentary benefits check before any procedure. No surprises.
210-405-1335Closed on major holidays.
3212 Napier Park, San Antonio, TX 78231
Stand-in image (Map © OpenStreetMap) — the live site embeds the interactive Google map here
No referral needed for your initial consultation.
Rather book by phone? Call (210) 405-1335.
