Uterine Artery Embolization for Fibroids with and Without Coexistent Adenomyosis: A Large U.S. Commercial Claims Comparative Effectiveness Study

PURPOSE: To compare short-term safety and long-term durability of uterine artery embolization (UAE) in patients with fibroid-only disease versus those with fibroids and coexistent adenomyosis. MATERIALS AND METHODS: We conducted a retrospective comparative effectiveness study of 13,098 patients aged 30-55 years undergoing UAE, identified from the MarketScan Commercial Database (2013-2025) and stratified by fibroid-only disease versus coexistent adenomyosis identified from administrative diagnosis codes. 30-day major adverse events (MAE) were compared using inverse probability of treatment weighted (IPTW) logistic regression. Long-term durability was evaluated through time-to-event analyses for any reintervention and for hysterectomy using IPTW-weighted Cox regression. RESULTS: No statistically significant difference in 30-day MAE was observed between cohorts (adjusted odds ratio 1.20; 95% CI 0.88-1.64; p = 0.24). Patients with coexistent fibroids and adenomyosis faced a higher hazard of hysterectomy (HR = 1.41; 95% CI 1.15-1.74, p = 0.001) and a borderline higher hazard of any reintervention (HR = 1.21; 95% CI 1.00-1.47, p = 0.046) compared with fibroids alone; only the hysterectomy association remained significant in all sensitivity analyses. At five years, the cumulative incidence of hysterectomy was 20.5% versus 13.9%, an absolute difference of 6.6 percentage points. CONCLUSION: No statistically significant difference in 30-day major adverse events was observed between groups. Coexistent adenomyosis was associated with a higher long-term hazard of hysterectomy, with a borderline association for any reintervention; estimates beyond five years are limited by short median follow-up and fewer patients remaining at risk.