Microwave Ablation for Adenomyosis: A Narrative Review of Principles, Outcomes and Clinical Integration

Pydi Saroja, Deepika Dewani, Manali Bhure, Sindhuka Meka
In: JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH · 2026 · doi:10.7860/jcdr/2026/89070.24722 · W7225105815
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This narrative review summarizes microwave ablation for adenomyosis, reporting substantial symptom relief and safety in cohorts while noting limited fertility evidence and the need for standardized protocols before it becomes an established treatment.

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This narrative review evaluates the principles, outcomes, and clinical integration of microwave ablation as a uterus-preserving treatment for adenomyosis. The authors summarize biophysical mechanisms and patient selection criteria, noting that published cohorts demonstrate substantial reductions in pain, bleeding, and lesion volume with low recurrence rates. However, the paper explicitly states that fertility evidence remains limited due to a lack of reliable pregnancy data and unresolved questions regarding uterine rupture risks during future pregnancies. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Adenomyosis is a chronic, oestrogen-responsive uterine disorder characterised by endometrial glands and stroma within the myometrium. It is commonly associated with dysmenorrhoea, heavy menstrual bleeding, chronic pelvic pain, subfertility, and impaired quality of life. Increasing demand for uterine preservation has stimulated interest in image-guided thermal therapies as alternatives to hysterectomy. Microwave Ablation (MWA) produces rapid dielectric heating and coagulative necrosis within targeted adenomyotic tissue while aiming to preserve the endometrial cavity, serosal surface, and unaffected myometrium. The present narrative review summarises the biophysical basis, patient selection, imaging requirements, procedural principles, clinical outcomes, reproductive evidence, safety considerations, and comparative position of MWA. Published cohorts report substantial reductions in pain, bleeding, symptom-severity scores, and uterine or lesion volume. In a 36-patient study of posterior-wall adenomyosis, complete relief of dysmenorrhoea and menorrhagia at 12 months was reported in 81.3% and 69.6% of evaluable patients, respectively, with an 11.1% recurrence rate and no major complications. However, fertility evidence remains limited: MWA-specific pregnancy and live-birth rates cannot yet be estimated reliably, and pooled reproductive outcomes for imageguided thermal ablation combine several modalities. Uterine rupture after MWA has not been quantified and remains an unresolved obstetric safety question. MWA is therefore a promising uterus-preserving option for carefully selected patients, but standardised eligibility criteria, energy-delivery protocols, outcome definitions, and prospective long-term reproductive studies are required before it can be considered an established fertility-restoring treatment.
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Microwave Ablation for Adenomyosis: A Narrative Review of Principles, Outcomes and Clinical Integration Correspondence Address : Dr. Pydi Saroja, Junior Resident, Department of Obstetrics and Gynaecology, JNMC, DMIHER, Sawangi, Wardha-442107, Maharashtra, India. E-mail: [email protected] Adenomyosis is a chronic, oestrogen-responsive uterine disorder characterised by endometrial glands and stroma within the myometrium. It is commonly associated with dysmenorrhoea, heavy menstrual bleeding, chronic pelvic pain, subfertility, and impaired quality of life. Increasing demand for uterine preservation has stimulated interest in image-guided thermal therapies as alternatives to hysterectomy. Microwave Ablation (MWA) produces rapid dielectric heating and coagulative necrosis within targeted adenomyotic tissue while aiming to preserve the endometrial cavity, serosal surface, and unaffected myometrium. The present narrative review summarises the biophysical basis, patient selection, imaging requirements, procedural principles, clinical outcomes, reproductive evidence, safety considerations, and comparative position of MWA. Published cohorts report substantial reductions in pain, bleeding, symptom-severity scores, and uterine or lesion volume. In a 36-patient study of posterior-wall adenomyosis, complete relief of dysmenorrhoea and menorrhagia at 12 months was reported in 81.3% and 69.6% of evaluable patients, respectively, with an 11.1% recurrence rate and no major complications. However, fertility evidence remains limited: MWA-specific pregnancy and live-birth rates cannot yet be estimated reliably, and pooled reproductive outcomes for image-guided thermal ablation combine several modalities. Uterine rupture after MWA has not been quantified and remains an unresolved obstetric safety question. MWA is therefore a promising uterus-preserving option for carefully selected patients, but standardised eligibility criteria, energy-delivery protocols, outcome definitions, and prospective long-term reproductive studies are required before it can be considered an established fertility-restoring treatment. Dysmenorrhoea, Fertility preservation, Heavy menstrual bleeding, Uterus-preserving treatment DOI: 10.7860/JCDR/2026/89070.24722 Date of Submission: Mar 26, 2026 Date of Peer Review: Jun 01, 2026 Date of Acceptance: Aug 02, 2026 Date of Publishing: Dec 01, 2026 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was informed consent obtained from the subjects involved in the study? No • For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Apr 01, 2026 • Manual Googling: Jul 29, 2026 • iThenticate Software: Jul 31, 2026 (4%) ETYMOLOGY: Author Origin EMENDATIONS: 6 - Emerging Sources Citation Index (Web of Science, thomsonreuters) - Index Copernicus ICV 2017: 134.54 - Academic Search Complete Database - Directory of Open Access Journals (DOAJ) - Embase - EBSCOhost - Google Scholar - HINARI Access to Research in Health Programme - Indian Science Abstracts (ISA) - Journal seek Database - Popline (reproductive health literature) - www.omnimedicalsearch.com

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