Uterine Adenomyosis

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Focused Ultrasound Therapy

Focused ultrasound is a rapidly evolving, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with adenomyosis. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the body without damaging surrounding normal tissue.

How it Works
Where the beams converge, focused ultrasound produces precise ablation (thermal destruction of tissue) enabling adenomyosis to be treated without surgery.

The primary options for treatment of adenomyosis include medication and surgery.

For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing or infection – at a lower cost and with a shorter recovery time. It can reach the desired target without damaging surrounding tissue and is repeatable, if necessary. The treatment has the potential to preserve fertility, because the uterus is not removed. Case studies have reported that women have conceived and had healthy babies after focused ultrasound.

Clinical Trials

clinical trial is underway in Finland that is assessing focused ultrasound to treat adenomyosis as well as the impact for fertility after the procedure. 

See a full list of adenomyosis clinical trials >

See a list of treatment sites > 
See a list of clinical trials sites >
See a list of laboratory research sites >

Regulatory Approval and Reimbursement

Several companies have approval to treat adenomyosis in Europe, Russia, China, Korea, the Middle East, and Taiwan.
To the best of our knowledge, focused ultrasound treatment of adenomyosis is not universally reimbursed by medical insurers in the US.

Notable Papers

Zhao TT, Pang LL, Yang LL, Li RN, Fan LX, Wen Y. Efficacy of high-intensity focused ultrasound combined with LNG-IUS for adenomyosis: a systematic review and meta-analysis. Arch Gynecol Obstet. 2022 Aug 10. doi: 10.1007/s00404-022-06720-z.

Chen H, Tan X, Xiong W, Xie Y, Wang X. Expulsion of adenomyotic lesion into uterine cavity after high-intensity focused ultrasound ablation. J Minim Invasive Gynecol. 2022 Jul 24:S1553-4650(22)00295-3. doi: 10.1016/j.jmig.2022.07.009.

Xiao X, Gong CM, Zhang R, Zhang L, Wang ZB. Clinical efficacy of focused ultrasound ablation surgery in the treatment of internal adenomyosis. Zhonghua Fu Chan Ke Za Zhi. 2022 Apr 25;57(4):259-264. doi: 10.3760/cma.j.cn112141-20210915-00521.

Lai THT, Seto MTY, Cheung VYT. Uterine rupture following ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids and adenomyosis. Ultrasound Obstet Gynecol. 2022 Jun 24. doi: 10.1002/uog.24983.

Lai M, Chen Y, Li H, Li Y, Wu S, Li Z, Zhang Q. A Modified Bowel Displacement Technique for Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery in the Treatment of Uterine Fibroids and Adenomyosis. J Comput Assist Tomogr. 2022 Apr 8. doi: 10.1097/RCT.0000000000001301.

Shun Wong FW, Li TK. Noninvasive High-intensity Focused Ultrasound Surgeries for Fibroids and Adenomyosis during COVID-19 Pandemic in Hong Kong: A Gynecologist’s Viewpoint. Gynecol Minim Invasive Ther. 2021 Nov 5;10(4):272-273. doi: 10.4103/GMIT.GMIT_18_21. eCollection 2021 Oct-Dec.

Cui Y, Yao L, Feng M, Zhang J, Zhang D. [Diffusion-weighted magnetic resonance imaging instead of contrast-enhanced imaging for evaluating immediate therapeutic efficacy of high-intensity focused ultrasound ablation of adenomyosis]. Nan Fang Yi Ke Da Xue Xue Bao. 2021 Oct 20;41(10):1583-1587. doi: 10.12122/j.issn.1673-4254.2021.10.19.

Huang Y, Zhou S, Wang J, Pang Z. Efficacy and safety of magnetic resonance-guided focused ultrasound surgery (MRgFUS) ablation in the management of abnormal uterine bleeding due to uterine leiomyoma or adenomyosis. Am J Transl Res. 2022 Jan 15;14(1):656-663. eCollection 2022.

Wong WSF, Lee MHM, Wong PH. A Journey from Learning a Noninvasive High-intensity Focused Ultrasound Surgical Treatment for Gynecological Diseases to Providing High-intensity Focused Ultrasound Services in Hong Kong. Gynecol Minim Invasive Ther. 2021 Apr 30;10(2):71-74. doi: 10.4103/GMIT.GMIT_23_21. eCollection 2021 Apr-Jun.

Gong C, Wang Y, Lv F, Zhang L, Wang Z. Evaluation of high intensity focused ultrasound treatment for different types of adenomyosis based on magnetic resonance imaging classification. Int J Hyperthermia. 2022;39(1):530-538. doi: 10.1080/02656736.2022.2052366.

Pang LL, Mei J, Fan LX, Zhao TT, Li RN, Wen Y. Efficacy of High-Intensity Focused Ultrasound Combined With GnRH-a for Adenomyosis: A Systematic Review and Meta-Analysis. Front Public Health. 2021 Aug 16;9:688264. doi: 10.3389/fpubh.2021.688264. eCollection 2021.

Peng Y, Dai Y, Yu G, Yang X, Wen C, Jin P. Clinical evaluation of HIFU combined with GnRH-a and LNG-IUS for adenomyosis patients who failed to respond to drug therapies: two-year follow-up results. Int J Hyperthermia. 2021;38(1):1271-1275. doi: 10.1080/02656736.2021.1967467.

Rodríguez J, Isern J, Pons N, Carmona A, Vallejo E, Cassadó J, De Marcos JA, Paraira M, Giménez N, Pessarrodona A. Pregnancy outcomes after ultrasound-guided high-intensity focused ultrasound (USgHIFU) for conservative treatment of uterine fibroids: experience of a single institution. Int J Hyperthermia. 2021 Sep;38(2):9-17. doi: 10.1080/02656736.2021.1908633.

Liu L, Wang T, Lei B. Image-guided thermal ablation in the management of symptomatic adenomyosis: a systematic review and meta-analysis. Int J Hyperthermia. 2021;38(1):948-962. doi: 10.1080/02656736.2021.1939443.

Xu Y, Zhou Z, Wang H, Shao L, Liu G. High-Intensity Focused Ultrasound Combined With Gonadotropin-Releasing Hormone Agonist or Levonorgestrel-Releasing Intrauterine System in Treating Dysmenorrhea of Severe Adenomyosis. J Comput Assist Tomogr. 2021 Mar-Apr 01;45(2):224-231. doi: 10.1097/RCT.0000000000001138.

Li X, Zhu X, He S, Jiang Z, Li H, Tian X, Long W, Xue M, Deng X, Ye M. High-intensity focused ultrasound in the management of adenomyosis: long-term results from a single center. Int J Hyperthermia. 2021;38(1):241-247. doi: 10.1080/02656736.2021.1886347.

Du CC, Wang YQ, Qu DC, Jiang LP, Yu X, Zhou HG. Magnetic resonance imaging T2WI hyperintense foci number and the prognosis of adenomyosis after high-intensity focused ultrasound treatment. Int J Gynaecol Obstet. 2021 Jan 9. doi: 10.1002/ijgo.13587.

Li W, Mao J, Liu Y, Zhu Y, Li X, Zhang Z, Bai X, Zheng W, Wang L. Clinical effectiveness and potential long-term benefits of high-intensity focused ultrasound therapy for patients with adenomyosis. J Int Med Res. 2020 Dec;48(12):300060520976492. doi: 10.1177/0300060520976492.

Zhou XJ, Zhao ZM, Liu P, Zhao CY, Lin YJ, Liu Y, Wang M, Tian C, Li HY, Hou CX, Li XM, Zhao ZY, Zhou YJ. Efficacy of high intensity focused ultrasound treatment for cystic adenomyosis: a report of four cases. Ann Palliat Med. 2020 Nov;9(6):3742-3749. doi: 10.21037/apm-20-1599.

Chen J, Porter AE, Kho KA. Current and Future Surgical and Interventional Management Options for Adenomyosis. Semin Reprod Med. 2020 Nov 5. doi: 10.1055/s-0040-1718921.

Li Z, Zhang J, Song Y, Yin X, Chen A, Tang N, Prince MR, Yang G, Wang H. Eur Utilization of radiomics to predict long-term outcome of magnetic resonance-guided focused ultrasound ablation therapy in adenomyosis. Radiol. 2020 Jul 28. doi: 10.1007/s00330-020-07076-1.

Haiyan S, Lin W, Shuhua H, Wang W. High-intensity focused ultrasound (HIFU) combined with gonadotropin-releasing hormone analogs (GnRHa) and levonorgestrel-releasing intrauterine system (LNG-IUS) for adenomyosis: a case series with long-term follow up. Int J Hyperthermia. 2019;36(1):1179-1185. doi: 10.1080/02656736.2019.1679892.

Nguyen MD. Magnetic Resonance-Guided Focused Ultrasound Surgery for Leiomyoma and Adenomyosis: An Alternative Nonvascular Approach. Gynecol Minim Invasive Ther. 2019 Oct 24;8(4):196-198. doi: 10.4103/GMIT.GMIT_19_19. eCollection 2019 Oct-Dec.

Dev B, Gadddam S, Kumar M, Varadarajan S. MR-guided focused ultrasound surgery: A novel non-invasive technique in the treatment of adenomyosis -18 month’s follow-up of 12 cases. Indian J Radiol Imaging. 2019 Jul-Sep;29(3):284-288. doi: 10.4103/ijri.IJRI_53_19. Epub 2019 Oct 30.

Lee JS, Hong GY, Lee KH, Song JH, Kim TE. Safety and Efficacy of Ultrasound-Guided High-Intensity Focused Ultrasound Treatment for Uterine Fibroids and Adenomyosis. Ultrasound Med Biol. 2019 Sep 25. pii: S0301-5629(19)31477-2. doi: 10.1016/j.ultrasmedbio.2019.08.022.

Keserci B, Duc NM. Magnetic resonance imaging features influencing high-intensity focused ultrasound ablation of adenomyosis with a nonperfused volume ratio of ≥90% as a measure of clinical treatment success: retrospective multivariate analysis. Int J Hyperthermia. 2018 Oct 11:1-11. doi: 10.1080/02656736.2018.1516301.

Guo Q, Xu F, Ding Z, Li P, Wang X, Gao B. High intensity focused ultrasound treatment of adenomyosis: a comparative study. Int J Hyperthermia. 2018 Oct 11:1-5. doi: 10.1080/02656736.2018.1509238.

Liu Y, Zhang WW, He M, Gong C, Xie B, Wen X, Li D, Zhang L. Adverse effect analysis of high-intensity focused ultrasound in the treatment of benign uterine diseases. Int J Hyperthermia. 2018 May 24:1-6. doi: 10.1080/02656736.2018.1473894.

Jingqi W, Lu Z, Jun Z, Yuhong M, Wei Y, Lifeng R, Chengbing J, Dobromir DD, Hui Z, Kun Z. Clinical Usefulness of the Microbubble Contrast Agent SonoVue in Enhancing the Effects of High-Intensity Focused Ultrasound for the Treatment of Adenomyosis. J Ultrasound Med. 2018 Apr 24. doi: 10.1002/jum.14638.

Dueholm M. Minimally invasive treatment of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2018 Feb 15. pii: S1521-6934(18)30034-8. doi: 10.1016/j.bpobgyn.2018.01.016.

Xiao-Ying Z, Ying-Shu G, Jiu-Mei C, Jin-Juan W, Hong Y, Chun-Yi Z, Hua D. Effect of pre-treatment with gonadotropin-releasing hormone analogue GnRH-α on high-intensity focussed ultrasound ablation for diffuse adenomyosis: a preliminary study. Int J Hyperthermia. 2018 Mar 2:1-9. doi: 10.1080/02656736.2018.1440014.

Hou Y, Qin Z, Fan K, Xu Y, Huang X. Combination therapeutic effects of high intensity focused ultrasound and Metformin for the treatment of adenomyosis. Exp Ther Med. 2018 Feb;15(2):2104-2108. doi: 10.3892/etm.2017.5601. Epub 2017 Dec 6.

Ou KY, Jeng CJ, Long CY, Chuang L. Re: Pregnancy outcomes in patients with uterine fibroids treated with ultrasound-guided high-intensity focused ultrasound: Is the noninvasive nature of HIFU ablation for uterine fibroids and adenomyosis setting patients up for future operative delivery? BJOG. 2018 May;125(6):762-763. doi: 10.1111/1471-0528.15114. Epub 2018 Feb 6. No abstract available.

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International Approval
Clinical Trials