Background
Uterine artery embolisation (UAE) is a possible uterine‐sparing treatment option for women with unsuccessful conservative management for adenomyosis‐related heavy menstrual bleeding (HMB) and dysmenorrhoea.

Aim
To conduct a clinical audit on the efficacy and safety of UAE for symptomatic adenomyosis.

Materials and Methods
Retrospective review of 309 women who underwent UAE identified 117 women with magnetic resonance imaging features of adenomyosis (junctional zone thickness ≥ 12 mm). Overall success and HMB control were rated by women. Visual analogue scale (VAS) pain score, Uterine Fibroid Symptom and health‐related Quality of Life (UFS‐QoL) symptoms score and quality of life score were also used to measure outcome.

Results
One hundred and fifteen women (98%) were available for outcome evaluation. The mean follow‐up was 22.5 months. Overall clinical success was achieved in 102/115 (89%) women; HMB control was achieved in 91/104 (88%); dysmenorrhea relief was achieved in 94/104 (90%), with VAS reduction of 6.13 (P < 0.001), Mean symptoms score was reduced from 58 to 17 at 12 months (P < 0.001) and QoL score increased from 42 to 88 at 12 months (P < 0.001). Hysterectomy was performed on six (5%) women. There were three (3%) mild groin haematomatas and three (3%) mild subacute complications (one possible endometritis, two urinary tract infections; all responded to oral antibiotics). Two women had unintended pregnancies which were complicated. Conclusions In this clinical audit UAE was found to be an effective uterine‐sparing option for women who had unsuccessful conservative treatments for adenomyosis‐related HMB and dysmenorrhoea. There were no major complications. Two women had unintended pregnancies that were complicated.