High-intensity focused ultrasound for endometrial ablation in adenomyosis: A clinical study

High-intensity focused ultrasound for endometrial ablation in adenomyosis: A clinical study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article High-intensity focused ultrasound for endometrial ablation in adenomyosis: A clinical study Siyun Wu, Jun Liu, Xiaoshan Liu, Yanhua Han This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2958614/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study aimed to investigate the clinical efficacy of endometrial ablation with high-intensity focused ultrasound (HIFU) for symptom relief in women with adenomyosis. Between July 2014 and July 2020, 167 patients with adenomyosis treated at the Zhongshan City People’s Hospital were enrolled in this study. Patients were divided into two groups according to patient aspirations: the control group, including patients who only underwent ablation of adenomyosis lesions (group A) and the treatment group, including patients who underwent removal of adenomyosis lesions and endometrial ablation (group B). The reduced dysmenorrhea scores (visual analog scale) and menstrual volume scores (pictorial blood assessment chart) were measured before and after treatment. Scores were obtained by subtracting postoperative scores from preoperative scores and were compared to determine whether the symptoms had alleviated. Compared with the menstrual volume of group A, group B showed significant improvements. The average relief rates of dysmenorrhea in the two groups also showed significant improvement. However, the scores in group B showed significant improvement compared with those in group A. Therefore, the findings suggest that endometrial ablation using HIFU may be superior to conventional therapy for adenomyosis at improving the symptoms of increased menstruation. Health sciences/Health care Health sciences/Medical research High-intensity focused ultrasound Magnetic resonance imaging Adenomyosis Endometrium Dysmenorrhea Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Adenomyosis is a benign uterine disease characterized by invasion of the endometrial glands and stroma in the uterus. It is a very common gynecological disorder that affects people of reproductive age and compromises their quality of life. This condition is frequently the underlying cause of dysmenorrhea, menorrhagia, and urinary dysfunction and can impact fertility. The distinguishing factors of magnetic resonance imaging (MRI) in adenomyosis include a focal or uneven width of the junction zone, low signal intensity in the junctional zone, high signal spots on T2-weighted images scattered within the junctional zone during hemorrhage, and unclear zone margins. [ 1 ] Traditionally, adenomyosis has been treated medically or surgically. Currently, hysterectomy is the only curative treatment for adenomyosis. The boundary of the adenomyotic lesion is unclear, making it difficult to completely remove the lesions. Conservative surgery, adenomyomectomy, has proven to be effective only in approximately 50% of the patients, and the recurrence rate is very high. [ 2 ] In addition, there is no specific treatment for patients who wish to retain their uterus or remain fertile. Thus, it is important to explore effective, safe, and less invasive treatment strategies for these patients. Uterus-conserving treatment of adenomyosis is a clinical challenge, and the margins of adenomyotic lesions are often ill-defined, posing difficulties for surgical resection. High-intensity focused ultrasound (HIFU), an emerging non-invasive treatment, features good tissue penetration and can induce coagulation necrosis of the targeted lesion. It does so through thermal and biological effects caused by the instant temperature increase from energy generated by ultrasound waves focused on the target within the body. [ 3 ] Although it is difficult to ablate the adenomyotic lesion completely using HIFU, this treatment causes little to no injury to the normal surrounding tissue. HIFU has been used to treat patients with symptomatic adenomyosis. Recently, several studies have investigated the role of HIFU in adenomyosis treatment and has been shown to be safe and effective. [ 4 ] However, most studies have focused on patients with dysmenorrhea, rather than on patients with menorrhagia. Therefore, this study aimed to investigate the clinical efficacy of the endometrial HIFU ablation for symptom relief in patients with adenomyosis. Methods Patients Between July 2014 and July 2020, 167 patients with adenomyosis were treated at Zhongshan City People’s Hospital and were enrolled in this study. The diagnosis of adenomyosis was confirmed using preprocedural MRI. All patients signed an informed consent form before HIFU treatment. Patients were divided into two groups according to the patients’ aspirations: the control group (group A), only adenomyosis lesions ablated with HIFU, and treatment group (group B), adenomyosis lesions and endometrial ablation with HIFU. Patients undergoing endometrial ablation were likely to develop infertility; therefore, they were fully informed, and consent was obtained before joining the treatment group. Patients who wished to preserve fertility were assigned to group A. The inclusion criteria were as follows: premenopausal adult women (age > 18 years) presenting with clinical symptoms of dysmenorrhea and/or menorrhagia and agreed to undergo periodic checkups. The exclusion criteria were clinical examination or ultrasonography findings showing endometrial disease, pelvic endometriosis, or other uncontrolled systemic diseases and menstruation, pregnancy, or lactation. HIFU ablation HIFU was performed using an ultrasound-guided HIFU system (USgHIFU;JC200; Haifu Medical Technology Co., Ltd., Chongqing, China). The patients were preoperatively administered fentanyl and midazolam for sedation and analgesia. They were placed in the prone position on the HIFU treatment table to enable their skin to be in full contact with degassed water. A degassed water balloon was placed between the transducer and anterior abdominal wall to compress or push away the bowel. The treatment started from the center of the lesion as point sonication. The sonication power ranged from 350 to 400 W. During the procedure, the treatment area and sonication intensity were adjusted based on changes in the gray scale on ultrasound and patient tolerance. During treatment, patients were requested to lie still and report any discomfort, including burning of the skin or lower abdominal, leg, sciatic, and buttock pain. [5] Post-treatment examination All patients underwent MRI after HIFU to define the condition of the endometrium and evaluate the non-perfused volume (NPV). The volume of adenomyotic lesions and NPV were measured using the following equation for the prolate ellipsoid: [6] volume = 0.5233 *a *b *c (a, b, c are the longitudinal, anteroposterior, and transverse dimensions, respectively). The volume of adenomyotic lesions was defined as the volume of the part of the uterus where the focal adenomyotic lesions were located (Figure 1). The volume of the ablation lesions was defined as the volume of the non-perfused area (Figure 2). The NPV ratio (NPVR) was defined as the NPV divided by the lesion volume, NPVR = NPV/volume of the adenomyotic lesion × 100%. Successful treatment [7] with HIFU was defined as an NPV of ≥1 cm 3 in the planned ablation zone. The endometrium of the uterine cavity is an inverted triangle, and the uterine cavity has two sides. The area of the endometrium was measured using the following equation: area = 0.5*a × b (a and b are the longitudinal and transverse dimension, respectively) × 2. The measurements of the area of the intact endometrium and ablated endometrium were based on preoperative (Figure 3) and postoperative MRI findings (Figure 4), respectively. The ablation rate was defined as the area of frustrated endometrium divided by the area of endometrium ablation rate = (area of frustrated endometrium / area of endometrium) × 100%. Successful treatment with HIFU was determined as the occurrence of a destruction rate of ≥25%. This study was approved by the Ethics Clerk Association of Zhongshan City People’s Hospital, all experiments were performed in accordance with relevant guidelines and regulations. Evaluation of clinical symptoms after treatment All adverse events and complications were recorded by a nurse during and after the procedure to examine the safety of HIFU. Follow-ups were performed by staff via telephone to register all post-surgical symptoms and complaints. There were two main observation indicators: dysmenorrhea and menstrual volume. The intensity of dysmenorrhea was assessed using a visual analog scale (VAS) score ranging from 0 to 10. [8] Menstrual volumes were scored according to patients’ descriptions of pictorial blood assessment chart methods（PBAC）. [9] The remission rate and clinical effectiveness were evaluated at 3, 6, and 12 months after HIFU ablation. The reduced dysmenorrhea and menstrual volume scores before and after treatment, subtracted from the preoperative score by the postoperative score, were compared to determine whether the symptoms had alleviated. Symptoms were considered alleviated using the following criteria: (1) inefficient, with score reduction of 20%; (2) partial relief, with score reduction of 20%–50%; (3) significant relief, with score reduction of 50%–80%; and (4) complete relief, with score reduction of 80%. Clinical relief included partial, significant, and complete relief. [10-12] Statistical analysis Data are presented as mean ± standard deviation. SPSS (SPSSAU) was used for data analysis. The t-test was performed to compare the variables between the two groups. Statistical significance was set at a p-value of <0.05. Results Baseline patient characteristics Overall, 167 patients with adenomyosis underwent ultrasound-guided HIFU (USgHIFU) ablation. Eligible patients were divided into two groups: the control group (69 patients) and treatment group (98 patients). The average age of the patients was 39.72 ± 5.49 years (group A) and 40.15 ± 5.38 years (group B), with no significant differences between the groups. All patients successfully underwent complete procedure and treatment. The destruction rates of the endometrium were 0.36 ± 0.61% (group A) and 43.2 ± 21.1% (group B), respectively, and the difference between the two groups was statistically significant (Table 1 ). Patients in group A had endometrial ablation caused by poor energy control; however, this occurred in only a small number of patients, and the ablation rate was < 5%. Table 1 Baseline characteristics of patients Group A (n = 69) Group B (n = 98) P Age (years) 39.72 ± 5.49 40.15 ± 5.38 0.616 Destruction rate of the endometrium (%) 0.36 ± 0.61 43.2 ± 21.1 0.00** ** p < 0.01 Results of treatment As shown in Table 2 , the HIFU treatment settings and procedures displayed no significant difference in the time of treatment between patients in the groups. A significant difference was noted in NPVR: 69.77 ± 17.92% was achieved in group A and 81.63 ± 15.16% in group B. Table 2 HIFU treatment results in patients of the two groups Group A (n = 69) Group B (n = 98) P Time of treatment(s) 881.57 ± 458.01 874.48 ± 417.81 0.918 NPVR (%) 69.77 ± 17.92 81.63 ± 15.16 0.00** ** p < 0.01 HIFU: high-intensity focused ultrasound Symptom relief The clinical efficacy rates of dysmenorrhea (score reduction of 20–100%) in group A at 3, 6, and 12 months were 81.16%, 86.96%, and 85.50%, respectively. The clinical efficacy rates of group B were 95.91%, 97.95%, and 97.95%, respectively. There was a significant difference in the clinical efficacy rates between the two groups (Table 3 ). Table 3 Clinical effective rate of VAS in patient with dysmenorrhea after HIFU treatment Follow-up time Group A (n = 69) Group B (n = 98) P 3 months 56 (81.16%) 94 (95.91%) 0.00** 6 months 60 (86.96%) 96 (97.95%) 0.00** 12 months 59 (85.50%) 96 (97.95%) 0.00** ** p < 0.01 VAS: visual analog scale; HIFU: high-intensity focused ultrasound As shown in Table 4 , the clinical efficacy rates of menstrual volume (score reduction of 20–100%) in group A at 3, 6 and 12 months were 24.63%, 30.43%, and 36.23%, respectively, and in group B were 89.80%, 95.91%, and 94.80%, respectively. There was a significant difference in the clinical efficacy rates between the two groups. Table 4 Clinical effective rate of menstrual volumes in patients after HIFU treatment Follow-up time Group A (n = 69) Group B (n = 98) P 3 months 17 (24.63%) 88 (89.80%) 0.00** 6 months 21 (30.43%) 94 (95.91%) 0.00** 12 months 25 (36.23%) 93 (94.80%) 0.00** ** p < 0.01 HIFU: high-intensity focused ultrasound Table 5 shows the reduction in VAS score after HIFU treatment compared with that before treatment in both groups. The median dysmenorrhea score of group A patients after treatment decreased by 3.23 ± 2.08, 3.59 ± 2.07, and 3.87 ± 2.31 points at 3, 6, and 12 months, respectively. Patients in group B had median reduction of 5.03 ± 1.87, 5.55 ± 1.66, and 5.68 ± 1.70 points in their dysmenorrhea scores at 3, 6, and 12 months, respectively. Table 5 Reduction of VAS in patients after HIFU treatment Time Group t value p A (n = 69) B (n = 98) 3 months 3.23 ± 2.08 5.03 ± 1.87 5.729 0.000** 6 months 3.59 ± 2.07 5.55 ± 1.66 6.502 0.000** 12 months 3.87 ± 2.31 5.68 ± 1.70 5.559 0.000** ** p < 0.01 VAS: visual analog scale; HIFU: high-intensity focused ultrasound Table 6 shows the reduction in menstrual volume after HIFU treatment compared with that before treatment in both groups. The median menstrual volumes of group A patients after treatment decreased by 14.64 ± 26.63, 18.64 ± 28.77, and 20.87 ± 29.71 points at 3, 6, and 12 months, respectively. Patients in group B had median reduction of 69.52 ± 31.38, 83.35 ± 28.66, and 86.18 ± 28.30 points in their menstrual volumes at 3, 6, and 12 months, respectively. There was a significant difference (P < 0.05) between the two groups in this regard. No complications occurred during the follow-up. Table 6 Reduction of menstrual volumes in patients after HIFU treatment Time Group t value p 1.0 (n = 69) 2.0 (n = 98) 3 months 14.64 ± 26.63 69.52 ± 31.38 11.833 0.000** 6 months 18.64 ± 28.77 83.35 ± 28.66 14.344 0.000** 12 months 20.87 ± 29.71 86.18 ± 28.30 14.385 0.000** ** p < 0.01 HIFU: high-intensity focused ultrasound Discussion Adenomyosis is a common gynecological disease with an increasing prevalence. [ 13 ] Several recent studies have demonstrated the safety and efficacy of HIFU ablation in the treatment of adenomyosis. [ 14 ] However, most studies have focused on dysmenorrhea and have ignored the symptoms of heavy menstruation. The relief rate of dysmenorrhea in our study at the 1-year follow-up after treatment was above 80%, consistent with that reported in Liu’s study. [ 8 ] The dysmenorrhea score decreased significantly in the treatment group compared with that in the control group, indicating the effectiveness of the treatment (Fig. 5 ). This finding may be related to the difference in NPVR between the two groups. Furthermore, this observation was highlighted in a regression analysis of factors affecting adenomyosis treatment published by Gong et al. [ 15 ] This study conducted a multivariate analysis of the effect of HIFU treatment for adenomyosis and found that NPVR was the most influential independent factor. Moreover, according to Guo et al. [ 16 ] the symptoms of menorrhagia can improve in patients with adenomyosis treated with HIFU alone. The patients in the control group in this study were also treated with HIFU alone, and the remission rate of menorrhagia symptoms was only 24–36% during the 1-year follow-up; however, the remission rate in the treatment group was significantly higher (> 80%). In addition, the improvement in menstrual scores before and after treatment in the two groups was compared with the declining value of the score. The decrease in the menstrual score in the treatment group was significantly greater than that in the control group (Fig. 6 ), indicating that the menstrual volume in the treatment group had significantly improved after endometrial ablation. A recent study [ 17 ] further showed that HIFU therapy can improve menorrhagia in adenomyosis to a small extent. The endometrial ablation method for menorrhagia in this study was a remedy for this deficiency. In this study, the two groups of patients were not treated with gonadotropin-releasing hormone (GNRH) after HIFU. According to a study published by Fang et al. , [ 18 ] GNRH combined with HIFU can control menstrual volume more effectively after ablation for adenomyosis. However, this study aimed to evaluate the effect of endometrial ablation on menstrual volume control; therefore, GNRH was not combined with treatment. Clinical studies of GNRH combined with ablation of the intima can be conducted in the future to clarify the relationship. In this study, endometrial ablation was performed via HIFU in patients with adenomyosis to observe its therapeutic effect. The results showed that the therapeutic effect of this treatment was better than that in patients without endometrial ablation. However, there are some limitations to this study. First, the sample size was limited, and this study was a nonrandomized controlled trial. Second, some symptomatic patients in both groups experienced no relief at all, which may be related to the ablation rate. Patients with a high ablation rate had a correspondingly high rate of symptom relief compared with those with a low ablation rate. Further studies should be conducted to confirm this conclusion. In conclusion, endometrial ablation is more effective than conventional therapy for the treatment of adenomyosis in improving symptoms of increased menstruation. Both treatments were effective in improving menstrual cramps; however, endometrial ablation was preferable. Declarations Contribution What are the novel findings of this work? Ablation of the endometrium is more beneficial for menorrhagia in adenomyosis. What are the clinical implications of this work? Endometrial ablation, a non-invasive treatment, can be widely used in patients with adenomyosis. Acknowledgements The authors would like to express their gratitude to Professor Yuanyuan Su, MD for her kind advice and support in the preparation of the manuscript. Author Contributions Siyun Wu was responsible for data analysis and drafting the manuscript. Yanhua Han modified the contents of the manuscript. Jun Liu performed HIFU on the patient. Xiaoshan Liu was responsible for the patient's outpatient follow-up. Data availability statement The data that support the findings of this study are available from the corresponding author, Yanhua Han, upon reasonable request. Competing Interests: The authors declare no competing interests. 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Guo, Y., Duan, H., Cheng, J. & Zhang, Y. Gonadotrophin-releasing hormone agonist combined with high-intensity focused ultrasound ablation for adenomyosis: a clinical study. BJOG 124 Supplement 3, 7–11 (2017). Li, W. et al. Clinical effectiveness and potential long-term benefits of high-intensity focused ultrasound therapy for patients with adenomyosis. J. Int. Med. Res. 48, 300060520976492 (2020). Yang, X., Zhang, X. F., Lin, B., Feng, X. & Aili, A. Combined therapeutic effects of HIFU, GnRH-a and LNG-IUS for the treatment of severe adenomyosis. Int. J. Hyperthermia 36, 486–492 (2019). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2958614","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":207988044,"identity":"6ca7f284-3ce9-483d-b139-3bcbcb94e197","order_by":0,"name":"Siyun Wu","email":"","orcid":"","institution":"Zhongshan City People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Siyun","middleName":"","lastName":"Wu","suffix":""},{"id":207988046,"identity":"0a346fef-1ecd-403d-bc75-9efe31d11a13","order_by":1,"name":"Jun Liu","email":"","orcid":"","institution":"Zhongshan City People’s 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2","display":"","copyAsset":false,"role":"figure","size":6988665,"visible":true,"origin":"","legend":"\u003cp\u003eThe measurement of the volume of the destroyed lesions (volume = 0.5233XaXbXc)\u003c/p\u003e","description":"","filename":"FIG.2Themeasurementofthevolumeofthedestroyedlesionsvolume0.5233XaXbXc.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2958614/v1/ba549e70ada1f11e75c69ad1.jpg"},{"id":38401532,"identity":"f01d3ffc-7b0c-4fc4-aad1-1ba838512f26","added_by":"auto","created_at":"2023-06-12 14:19:15","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":4947929,"visible":true,"origin":"","legend":"\u003cp\u003eThe measurement of the area of endometrium（area=0.5XaXbX2 ）\u003c/p\u003e","description":"","filename":"FIG.3Themeasurementoftheareaofendometriumarea0.5XaXbX2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2958614/v1/93ef7adf45304331e2ef9dc8.jpg"},{"id":38401530,"identity":"1e691e65-a7fa-4911-8d24-164705d98df5","added_by":"auto","created_at":"2023-06-12 14:19:15","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":6616279,"visible":true,"origin":"","legend":"\u003cp\u003eThe measurement of the area of frustrate endometrium（ area=0.5XaXb+0.5XcXd ）\u003c/p\u003e","description":"","filename":"FIG.4Themeasurementoftheareaoffrustrateendometriumarea0.5XaXb0.5XcXd.jpg","url":"https://assets-eu.researchsquare.com/files/rs-2958614/v1/802a3e260a57eaa13c2f4aa0.jpg"},{"id":38401528,"identity":"5d8a2c0b-94db-4baf-9300-4469689f6f0a","added_by":"auto","created_at":"2023-06-12 14:19:14","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":66971,"visible":true,"origin":"","legend":"\u003cp\u003eReduction of VAS in patients after HIFU treatment\u003c/p\u003e","description":"","filename":"FIG5.ReductionofVASinpatientsafterHIFUtreatment.png","url":"https://assets-eu.researchsquare.com/files/rs-2958614/v1/489cd3bfdec9882ae17cefaf.png"},{"id":38401529,"identity":"7cd18356-3b78-4f27-b48b-c370ec133ffd","added_by":"auto","created_at":"2023-06-12 14:19:14","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":65497,"visible":true,"origin":"","legend":"\u003cp\u003eReduction of menstrual volumes in patients after HIFU treatment\u003c/p\u003e","description":"","filename":"FIG6.ReductionofmenstrualvolumesinpatientsafterHIFUtreatment.png","url":"https://assets-eu.researchsquare.com/files/rs-2958614/v1/152d99a293b891b722fbc2a3.png"},{"id":42212761,"identity":"28705614-6212-4360-aa94-3025f5c4393b","added_by":"auto","created_at":"2023-08-28 04:37:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":802236,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2958614/v1/0768cc9a-780f-44a0-809a-7a99ffeeabcf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"High-intensity focused ultrasound for endometrial ablation in adenomyosis: A clinical study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAdenomyosis is a benign uterine disease characterized by invasion of the endometrial glands and stroma in the uterus. It is a very common gynecological disorder that affects people of reproductive age and compromises their quality of life. This condition is frequently the underlying cause of dysmenorrhea, menorrhagia, and urinary dysfunction and can impact fertility. The distinguishing factors of magnetic resonance imaging (MRI) in adenomyosis include a focal or uneven width of the junction zone, low signal intensity in the junctional zone, high signal spots on T2-weighted images scattered within the junctional zone during hemorrhage, and unclear zone margins.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTraditionally, adenomyosis has been treated medically or surgically. Currently, hysterectomy is the only curative treatment for adenomyosis. The boundary of the adenomyotic lesion is unclear, making it difficult to completely remove the lesions. Conservative surgery, adenomyomectomy, has proven to be effective only in approximately 50% of the patients, and the recurrence rate is very high.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e In addition, there is no specific treatment for patients who wish to retain their uterus or remain fertile. Thus, it is important to explore effective, safe, and less invasive treatment strategies for these patients.\u003c/p\u003e \u003cp\u003eUterus-conserving treatment of adenomyosis is a clinical challenge, and the margins of adenomyotic lesions are often ill-defined, posing difficulties for surgical resection. High-intensity focused ultrasound (HIFU), an emerging non-invasive treatment, features good tissue penetration and can induce coagulation necrosis of the targeted lesion. It does so through thermal and biological effects caused by the instant temperature increase from energy generated by ultrasound waves focused on the target within the body.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e Although it is difficult to ablate the adenomyotic lesion completely using HIFU, this treatment causes little to no injury to the normal surrounding tissue. HIFU has been used to treat patients with symptomatic adenomyosis. Recently, several studies have investigated the role of HIFU in adenomyosis treatment and has been shown to be safe and effective.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e However, most studies have focused on patients with dysmenorrhea, rather than on patients with menorrhagia. Therefore, this study aimed to investigate the clinical efficacy of the endometrial HIFU ablation for symptom relief in patients with adenomyosis.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween July 2014 and July 2020, 167 patients with adenomyosis were treated at Zhongshan City People’s Hospital and were enrolled in this study. The diagnosis of adenomyosis was confirmed using preprocedural MRI. All patients\u0026nbsp;signed an informed consent form before HIFU treatment. Patients were divided into two groups according to the patients’ aspirations: the control group (group A), only adenomyosis lesions ablated with HIFU, and treatment group (group B), adenomyosis lesions and endometrial ablation with HIFU. Patients undergoing endometrial ablation were likely to develop infertility; therefore, they were fully informed, and consent was obtained before joining the treatment group. Patients who wished to preserve fertility were assigned to\u0026nbsp;group A.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were as follows: premenopausal adult women (age \u0026gt; 18 years) presenting with clinical symptoms of dysmenorrhea and/or menorrhagia and agreed to undergo periodic checkups. The exclusion criteria were clinical examination or ultrasonography findings showing endometrial disease, pelvic endometriosis, or other uncontrolled systemic diseases and menstruation, pregnancy, or lactation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eHIFU ablation\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHIFU was performed using an ultrasound-guided HIFU system (USgHIFU;JC200; Haifu Medical Technology Co., Ltd., Chongqing, China). The patients were preoperatively administered fentanyl and midazolam for sedation and analgesia. They were placed in the prone position on the HIFU treatment table to enable their skin to be in full contact with degassed water. A degassed water balloon was placed between the transducer and anterior abdominal wall to compress or push away the bowel. The treatment started from the center of the lesion as point sonication. The sonication power ranged from 350 to 400 W. During the procedure, the treatment area and sonication intensity were adjusted based on changes in the gray scale on ultrasound and patient tolerance. During treatment, patients were requested to lie still and report any discomfort, including burning of the skin or lower abdominal, leg, sciatic, and buttock pain.\u003csup\u003e[5]\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePost-treatment examination\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients underwent MRI after HIFU to define the condition of the endometrium and evaluate the non-perfused volume (NPV). The volume of adenomyotic lesions and NPV were measured using the following equation for the prolate ellipsoid:\u003csup\u003e[6]\u003c/sup\u003e volume = 0.5233 *a *b *c (a, b, c are the longitudinal, anteroposterior, and transverse dimensions, respectively). The volume of adenomyotic lesions was defined as the volume of the part of the uterus where the focal adenomyotic lesions were located (Figure 1). The volume of the ablation lesions was defined as the volume of the non-perfused area (Figure 2). The NPV ratio (NPVR) was defined as the NPV divided by the lesion volume, NPVR = NPV/volume of the adenomyotic lesion × 100%. Successful treatment\u003csup\u003e[7]\u003c/sup\u003e with HIFU was defined as an NPV of ≥1 cm\u003csup\u003e3\u003c/sup\u003e in the planned ablation zone.\u003c/p\u003e\n\u003cp\u003eThe endometrium of the uterine cavity is an inverted triangle, and the uterine cavity has two sides. The area of the endometrium was measured using the following equation: area = 0.5*a × b (a and b are the longitudinal and transverse dimension, respectively) × 2. The measurements of the area of the intact endometrium and ablated endometrium were based on preoperative (Figure 3) and postoperative MRI findings (Figure 4), respectively. The ablation rate was defined as the area of frustrated endometrium divided by the area of endometrium ablation rate = (area of frustrated endometrium / area of endometrium) ×\u0026nbsp;100%. Successful treatment with HIFU was determined as the occurrence of a destruction rate of ≥25%.\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Clerk Association of Zhongshan City People’s Hospital, all experiments were performed in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEvaluation of clinical symptoms after treatment\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll adverse events and complications were recorded by a nurse during and after the procedure to examine the safety of HIFU. Follow-ups were performed by staff via telephone to register all post-surgical symptoms and complaints. There were two main observation indicators: dysmenorrhea and menstrual volume. The intensity of dysmenorrhea was assessed using a visual analog scale (VAS) score ranging from 0 to 10.\u003csup\u003e[8]\u0026nbsp;\u003c/sup\u003eMenstrual volumes were scored according to patients’ descriptions of pictorial blood assessment chart methods（PBAC）.\u003csup\u003e[9]\u003c/sup\u003e The remission rate and clinical effectiveness were evaluated at 3, 6, and 12 months after HIFU ablation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe reduced dysmenorrhea and menstrual volume scores before and after treatment, subtracted from the preoperative score by the postoperative score, were compared to determine whether the symptoms had alleviated. Symptoms were considered alleviated using the following criteria: (1) inefficient, with score reduction of 20%; (2) partial relief, with score reduction of 20%–50%; (3) significant relief, with score reduction of 50%–80%; and (4) complete relief, with score reduction of 80%. Clinical relief included partial, significant, and complete relief.\u003csup\u003e[10-12]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData are presented as mean ± standard deviation. SPSS (SPSSAU) was used for data analysis. The t-test was performed to compare the variables between the two groups. Statistical significance was set at a p-value of \u0026lt;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBaseline patient characteristics\u003c/h2\u003e \u003cp\u003eOverall, 167 patients with adenomyosis underwent ultrasound-guided HIFU (USgHIFU) ablation. Eligible patients were divided into two groups: the control group (69 patients) and treatment group (98 patients). The average age of the patients was 39.72\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49 years (group A) and 40.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38 years (group B), with no significant differences between the groups. All patients successfully underwent complete procedure and treatment. The destruction rates of the endometrium were 0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61% (group A) and 43.2\u0026thinsp;\u0026plusmn;\u0026thinsp;21.1% (group B), respectively, and the difference between the two groups was statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Patients in group A had endometrial ablation caused by poor energy control; however, this occurred in only a small number of patients, and the ablation rate was \u0026lt;\u0026thinsp;5%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e39.72\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e40.15\u0026thinsp;\u0026plusmn;\u0026thinsp;5.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDestruction rate of the endometrium (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e43.2\u0026thinsp;\u0026plusmn;\u0026thinsp;21.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eResults of treatment\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the HIFU treatment settings and procedures displayed no significant difference in the time of treatment between patients in the groups. A significant difference was noted in NPVR: 69.77\u0026thinsp;\u0026plusmn;\u0026thinsp;17.92% was achieved in group A and 81.63\u0026thinsp;\u0026plusmn;\u0026thinsp;15.16% in group B.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHIFU treatment results in patients of the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime of treatment(s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e881.57\u0026thinsp;\u0026plusmn;\u0026thinsp;458.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e874.48\u0026thinsp;\u0026plusmn;\u0026thinsp;417.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.918\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNPVR (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e69.77\u0026thinsp;\u0026plusmn;\u0026thinsp;17.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e81.63\u0026thinsp;\u0026plusmn;\u0026thinsp;15.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 HIFU: high-intensity focused ultrasound\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSymptom relief\u003c/h2\u003e \u003cp\u003eThe clinical efficacy rates of dysmenorrhea (score reduction of 20\u0026ndash;100%) in group A at 3, 6, and 12 months were 81.16%, 86.96%, and 85.50%, respectively. The clinical efficacy rates of group B were 95.91%, 97.95%, and 97.95%, respectively. There was a significant difference in the clinical efficacy rates between the two groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical effective rate of VAS in patient with dysmenorrhea after HIFU treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56 (81.16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94 (95.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60 (86.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96 (97.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e59 (85.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96 (97.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 VAS: visual analog scale; HIFU: high-intensity focused ultrasound\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the clinical efficacy rates of menstrual volume (score reduction of 20\u0026ndash;100%) in group A at 3, 6 and 12 months were 24.63%, 30.43%, and 36.23%, respectively, and in group B were 89.80%, 95.91%, and 94.80%, respectively. There was a significant difference in the clinical efficacy rates between the two groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical effective rate of menstrual volumes in patients after HIFU treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (24.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (89.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (30.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94 (95.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (36.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93 (94.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 HIFU: high-intensity focused ultrasound\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the reduction in VAS score after HIFU treatment compared with that before treatment in both groups. The median dysmenorrhea score of group A patients after treatment decreased by 3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08, 3.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07, and 3.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31 points at 3, 6, and 12 months, respectively. Patients in group B had median reduction of 5.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87, 5.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66, and 5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70 points in their dysmenorrhea scores at 3, 6, and 12 months, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReduction of VAS in patients after HIFU treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.23\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.59\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 VAS: visual analog scale; HIFU: high-intensity focused ultrasound\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e shows the reduction in menstrual volume after HIFU treatment compared with that before treatment in both groups. The median menstrual volumes of group A patients after treatment decreased by 14.64\u0026thinsp;\u0026plusmn;\u0026thinsp;26.63, 18.64\u0026thinsp;\u0026plusmn;\u0026thinsp;28.77, and 20.87\u0026thinsp;\u0026plusmn;\u0026thinsp;29.71 points at 3, 6, and 12 months, respectively. Patients in group B had median reduction of 69.52\u0026thinsp;\u0026plusmn;\u0026thinsp;31.38, 83.35\u0026thinsp;\u0026plusmn;\u0026thinsp;28.66, and 86.18\u0026thinsp;\u0026plusmn;\u0026thinsp;28.30 points in their menstrual volumes at 3, 6, and 12 months, respectively. There was a significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) between the two groups in this regard. No complications occurred during the follow-up.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReduction of menstrual volumes in patients after HIFU treatment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0 (n\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.64\u0026thinsp;\u0026plusmn;\u0026thinsp;26.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.52\u0026thinsp;\u0026plusmn;\u0026thinsp;31.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.64\u0026thinsp;\u0026plusmn;\u0026thinsp;28.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.35\u0026thinsp;\u0026plusmn;\u0026thinsp;28.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.87\u0026thinsp;\u0026plusmn;\u0026thinsp;29.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.18\u0026thinsp;\u0026plusmn;\u0026thinsp;28.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 HIFU: high-intensity focused ultrasound\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAdenomyosis is a common gynecological disease with an increasing prevalence.\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e Several recent studies have demonstrated the safety and efficacy of HIFU ablation in the treatment of adenomyosis.\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e However, most studies have focused on dysmenorrhea and have ignored the symptoms of heavy menstruation.\u003c/p\u003e \u003cp\u003eThe relief rate of dysmenorrhea in our study at the 1-year follow-up after treatment was above 80%, consistent with that reported in Liu\u0026rsquo;s study.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e The dysmenorrhea score decreased significantly in the treatment group compared with that in the control group, indicating the effectiveness of the treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This finding may be related to the difference in NPVR between the two groups. Furthermore, this observation was highlighted in a regression analysis of factors affecting adenomyosis treatment published by Gong \u003cem\u003eet al.\u003c/em\u003e\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e This study conducted a multivariate analysis of the effect of HIFU treatment for adenomyosis and found that NPVR was the most influential independent factor.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMoreover, according to Guo \u003cem\u003eet al.\u003c/em\u003e\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e the symptoms of menorrhagia can improve in patients with adenomyosis treated with HIFU alone. The patients in the control group in this study were also treated with HIFU alone, and the remission rate of menorrhagia symptoms was only 24\u0026ndash;36% during the 1-year follow-up; however, the remission rate in the treatment group was significantly higher (\u0026gt;\u0026thinsp;80%). In addition, the improvement in menstrual scores before and after treatment in the two groups was compared with the declining value of the score. The decrease in the menstrual score in the treatment group was significantly greater than that in the control group (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e), indicating that the menstrual volume in the treatment group had significantly improved after endometrial ablation. A recent study\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e further showed that HIFU therapy can improve menorrhagia in adenomyosis to a small extent. The endometrial ablation method for menorrhagia in this study was a remedy for this deficiency. In this study, the two groups of patients were not treated with gonadotropin-releasing hormone (GNRH) after HIFU. According to a study published by Fang \u003cem\u003eet al.\u003c/em\u003e,\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e GNRH combined with HIFU can control menstrual volume more effectively after ablation for adenomyosis. However, this study aimed to evaluate the effect of endometrial ablation on menstrual volume control; therefore, GNRH was not combined with treatment. Clinical studies of GNRH combined with ablation of the intima can be conducted in the future to clarify the relationship.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn this study, endometrial ablation was performed via HIFU in patients with adenomyosis to observe its therapeutic effect. The results showed that the therapeutic effect of this treatment was better than that in patients without endometrial ablation.\u003c/p\u003e \u003cp\u003eHowever, there are some limitations to this study. First, the sample size was limited, and this study was a nonrandomized controlled trial. Second, some symptomatic patients in both groups experienced no relief at all, which may be related to the ablation rate. Patients with a high ablation rate had a correspondingly high rate of symptom relief compared with those with a low ablation rate. Further studies should be conducted to confirm this conclusion.\u003c/p\u003e \u003cp\u003eIn conclusion, endometrial ablation is more effective than conventional therapy for the treatment of adenomyosis in improving symptoms of increased menstruation. Both treatments were effective in improving menstrual cramps; however, endometrial ablation was preferable.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eContribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhat are the novel findings of this work?\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAblation of the endometrium is more beneficial for menorrhagia in adenomyosis.\u003c/p\u003e\n\u003cp\u003eWhat are the clinical implications of this work?\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEndometrial ablation, a non-invasive treatment, can be widely used in patients with adenomyosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to Professor Yuanyuan Su, MD for her kind advice and support in the preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSiyun Wu was responsible for data analysis and drafting the manuscript. Yanhua Han modified the contents of the manuscript. Jun Liu performed HIFU on the patient. Xiaoshan Liu was responsible for the patient's outpatient follow-up.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author,\u0026nbsp;Yanhua Han, upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eSudderuddin, S., Helbren, E., Telesca, M., Williamson, R. \u0026amp; Rockall, A. MRI appearances of benign uterine disease. Clin. Radiol. 69, 1095\u0026ndash;1104 (2014).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eShrestha, A., Shrestha, R., Sedhai, L. B. \u0026amp; Pandit, U. Adenomyosis at hysterectomy: prevalence, patient characteristics, clinical profile and histopatholgical findings. Kathmandu Univ. Med. J. (KUMJ) 10, 53\u0026ndash;56 (2012).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eTsai, M. C., Chang, L. T. \u0026amp; Tam, K. W. Comparison of high-intensity focused ultrasound and conventional surgery for patients with uterine myomas: A systematic review and meta-analysis. J. Minim. Invasive Gynecol. 28, 1712\u0026ndash;1724 (2021).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eZhang, L., Rao, F. \u0026amp; Setzen, R. High intensity focused ultrasound for the treatment of adenomyosis selection criteria, efficacy, safety and fertility. Acta Obstet. Gynecol. Scand. 96, 707\u0026ndash;714 (2017).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFu, X., Huang, F., Chen, Y., Deng, Y. \u0026amp; Wang, Z. Application of dexmedetomidine-remifentanil in high-intensity ultrasound ablation of uterine fibroids: a randomised study. \u003cem\u003eBJOG\u003c/em\u003e 124 Supplement 3, 23\u0026ndash;29 (2017).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePeng, S. \u003cem\u003eet al.\u003c/em\u003e Factors influencing the dosimetry for high-intensity focused ultrasound ablation of uterine fibroids: a retrospective study. Med. (Baltim.) 94, e650 (2015).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eAhmed, M. \u003cem\u003eet al.\u003c/em\u003e; Interventional Oncolocy Sans Frontieres Expert Panel, Technology Assessment Committee of the Society of Interventional Radiology; Standard of Practice Committee on the Cardiovascular and Interventional Radiological Society of Europe. Image-guided tumor ablation: standardization of terminology and reporting criteria - a 10-year update. J. Vasc. Interv. Radiol. 25, 1691 \u0026ndash; 705.e4 (2014).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLiu, X. \u003cem\u003eet al.\u003c/em\u003e Clinical predictors of long-term success in ultrasound guided high-intensity focused ultrasound ablation treatment for adenomyosis: a retrospective study. Med. (Baltim.) 95, e2443 (2016).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHigham, J. M., O\u0026rsquo;Brien, P. M. \u0026amp; Shaw, R. W. Assessment of menstrual blood loss using a pictorial chart. Br. J. Obstet. Gynaecol. 97, 734\u0026ndash;739 (1990).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGoodwin, S. C. \u003cem\u003eet al.\u003c/em\u003e Reporting standards for uterine artery embolization for the treatment of uterine leiomyomata. J. Vasc. Interv. 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Res. 48, 300060520976492 (2020).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eYang, X., Zhang, X. F., Lin, B., Feng, X. \u0026amp; Aili, A. Combined therapeutic effects of HIFU, GnRH-a and LNG-IUS for the treatment of severe adenomyosis. Int. J. Hyperthermia 36, 486\u0026ndash;492 (2019).\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"High-intensity focused ultrasound, Magnetic resonance imaging, Adenomyosis, Endometrium, Dysmenorrhea","lastPublishedDoi":"10.21203/rs.3.rs-2958614/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2958614/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aimed to investigate the clinical efficacy of endometrial ablation with high-intensity focused ultrasound (HIFU) for symptom relief in women with adenomyosis. Between July 2014 and July 2020, 167 patients with adenomyosis treated at the Zhongshan City People’s Hospital were enrolled in this study. Patients were divided into two groups according to patient aspirations: the control group, including patients who only underwent ablation of adenomyosis lesions (group A) and the treatment group, including patients who underwent removal of adenomyosis lesions and endometrial ablation (group B). The reduced dysmenorrhea scores (visual analog scale) and menstrual volume scores (pictorial blood assessment chart) were measured before and after treatment. Scores were obtained by subtracting postoperative scores from preoperative scores and were compared to determine whether the symptoms had alleviated. Compared with the menstrual volume of group A, group B showed significant improvements. The average relief rates of dysmenorrhea in the two groups also showed significant improvement. However, the scores in group B showed significant improvement compared with those in group A. Therefore,\u003cstrong\u003e \u003c/strong\u003ethe findings suggest that\u003cstrong\u003e \u003c/strong\u003eendometrial ablation using HIFU may be superior to conventional therapy for adenomyosis at improving the symptoms of increased menstruation.\u003c/p\u003e","manuscriptTitle":"High-intensity focused ultrasound for endometrial ablation in adenomyosis: A clinical study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-06-12 14:19:10","doi":"10.21203/rs.3.rs-2958614/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"028675d7-0a9e-42eb-bfae-f2fea2334002","owner":[],"postedDate":"June 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":22220356,"name":"Health sciences/Health care"},{"id":22220357,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2023-08-28T04:29:23+00:00","versionOfRecord":[],"versionCreatedAt":"2023-06-12 14:19:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2958614","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2958614","identity":"rs-2958614","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}