- Last Updated: July 11, 2017
Adenomyosis occurs when tissue that usually lines the uterus grows into the muscular wall of the uterus. Like endometriosis, where the uterine lining implants outside the uterus, adenomyosis can cause pain and heavy bleeding.
The two conditions are distinct, but many women with adenomyosis also have endometriosis. Adenomyosis is a common condition that primarily affects middle-aged women or women who have had children. It can appear in two forms, a focal and a diffuse presentation. The focal presentation is where the growth of the tissue is in a readily defined area of the uterus, and this can easily be mistaken for uterine fibroids. The diffuse presentation is where the growth is widespread and diffusely defined. The cause of adenomyosis is not known.
Treatment of adenomyosis depends partly on the presence and severity of symptoms. Because the condition usually disappears after menopause, treatment also depends on how close a woman is to that stage. Women who have no symptoms and are nearing menopause may not receive treatment at all. For symptomatic and younger women, treatment options include oral medication, surgery, and recently there is some evidence that uterine artery embolization may be useful as well.
Focused Ultrasound Therapy
Focused ultrasound offers a potentially non-invasive treatment for adenomyosis. Guided by ultrasound or magnetic resonance imaging, the physician directs a focused beam of acoustic energy through the patient’s skin, fat layer, and abdominal muscles toward the adenomyosis. This beam heats and destroys the adenomyositic tissue without damaging nearby tissues or structures.
As a potentially non-invasive method, focused ultrasound may offer benefits in the treatment of adenomyosis, including:
- a shorter recovery time, with the patient often returning to work and other activities within a day;
- a lower rate of complications;
- rapid and durable resolution of adenomyosis symptoms; and
- 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.
Recent work has shown that improvements in care have enabled better results in both focal and diffuse adenomyosis care. The team ensured 10mm margins between the endometrium and the uterine wall, and there were no major differences between the focal and diffuse care in terms of overall response. The success rates for care in 2008 were 87%, and the results for the recent study for both focal and diffuse cases were 99.5%.
At present, there are two ongoing international clinical trials investigating the use of focused ultrasound for adenomyosis.
Regulatory Approval and Reimbursement
The InSightec ExAblate system has received approval in Europe for the treatment of adenomyosis.
To the best of our knowledge, focused ultrasound treatment of adenomyosis is not universally reimbursed by medical insurers in the US.
Zhang L, Rao F, Setzen R. High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility. Acta Obstet Gynecol Scand. 2017 Jun;96(6):707-714. doi: 10.1111/aogs.13159.
Feng Y, Hu L, Chen W, Zhang R, Wang X, Chen J. Safety of ultrasound-guided high-intensity focused ultrasound ablation for diffuse adenomyosis: A retrospective cohort study. Ultrason Sonochem. 2017 May;36:139-145. doi: 10.1016/j.ultsonch.2016.11.022.
Park J, Lee JS, Cho JH, Kim S. Effects of High-Intensity-Focused Ultrasound Treatment on Benign Uterine Tumor. J Korean Med Sci. 2016 Aug;31(8):1279-83. doi: 10.3346/jkms.2016.31.8.1279.
Gong C, Yang B, Shi Y, Liu Z, Wan L, Zhang H, Jiang D, Zhang L. Factors influencing the ablative efficiency of high intensity focused ultrasound (HIFU) treatment for adenomyosis: A retrospective study. Int J Hyperthermia. 2016 Aug;32(5):496-503. doi: 10.3109/02656736.2016.1149232.
Ferrari F, Arrigoni F, Miccoli A, Mascaretti S, Fascetti E, Mascaretti G, Barile A, Masciocchi C. Effectiveness of Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) in the uterine adenomyosis treatment: technical approach and MRI evaluation. Radiol Med. 2016 Feb;121(2):153-61. doi: 10.1007/s11547-015-0580-7.
Liu X, Wang W, Wang Y, Wang Y, Li Q, Tang J. Clinical Predictors of Long-term Success in Ultrasound-guided High-intensity Focused Ultrasound Ablation Treatment for Adenomyosis: A Retrospective Study. Medicine (Baltimore). 2016 Jan;95(3):e2443. doi: 10.1097/MD.0000000000002443.
Long L, Chen J, Xiong Y, Zou M, Deng Y, Chen L, Wang Z. Efficacy of high-intensity focused ultrasound ablation for adenomyosis therapy and sexual life quality. Int J Clin Exp Med. 2015 Jul 15;8(7):11701-7.
Xiong Y, Yue Y, Shui L, Orsi F, He J, Zhang L. Ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for the treatment of patients with adenomyosis and prior abdominal surgical scars: A retrospective study. Int J Hyperthermia. 2015;31(7):777-83. doi: 10.3109/02656736.2015.1071436.