Innovative application of high-intensity focused ultrasound combined with endometrial thermal balloon ablation in the treatment of adenomyosis: A cohort study

Objective: To evaluate the efficacy of high-intensity focused ultrasound (HIFU) combined with endometrial thermal balloon ablation (TBEA) for treating adenomyosis-related hypermenorrhagia. Methods: This retrospective cohort study included 120 patients diagnosed with adenomyosis-related hypermenorrhagia. Patients were divided into three groups: the HIFU combined with TBEA group (HIFU + TBEA, 34 cases), the HIFU combined with gonadotropin-releasing hormone agonist and intrauterine levonorgestrel intrauterine system (HIFU + GnRH-a + LNG-IUS, 51 cases) group and the HIFU (35 cases) group. Efficacy and safety were assessed using the pictorial blood loss assessment chart (PBAC), dysmenorrhea scores evaluated by the Numerical Rating Scale (NRS), quality of life measured by the Uterine Fibroid Symptom and Quality of Life scale (UFS-QOL), reintervention rates, success rates, satisfaction, and adverse effects at pretreatment and 1, 3, 6, 9, and 12 months posttreatment. Results: The HIFU + TBEA group showed significantly greater reductions in PBAC scores at 6, 9, and 12 months compared to the HIFU + GnRH-a + LNG-IUS group, and consistently lower scores than the HIFU group at all follow-up points. No significant differences in NRS scores or reintervention rates were observed between groups. Additionally, the HIFU + TBEA group reported higher UFS-QOL scores at 6 and 12 months posttreatment and greater satisfaction at 12 months posttreatment. Its success rate exceeded that of the HIFU group but was comparable to the HIFU + GnRH-a + LNG-IUS group. Serious adverse reactions were rare across all groups. Conclusion: HIFU combined with TBEA demonstrates good efficacy and safety, providing an effective long-term treatment option for adenomyosis-related hypermenorrhagia in patients without fertility needs. Synopsis: Evaluating HIFU + TBEA as an effective long-term treatment for adenomyosis-related hypermenorrhagia in patients without fertility needs.