HIFU combined with ethanol ablation or GnRH-a significantly improves adenomyosis treatment outcomes

Adenomyosis, a condition where endometrial tissue invades the myometrial muscle, causes severe dysmenorrhea and heavy menstrual bleeding, significantly impacting quality of life. Current treatments range from hormonal therapies to hysterectomy, but many patients seek less invasive, fertility-preserving options. High-Intensity Focused Ultrasound (HIFU) ablation offers a non-surgical approach, yet its standalone efficacy can be suboptimal. Investigating combination therapies with HIFU is crucial to enhance treatment outcomes, particularly by improving ablation efficiency and reducing recurrence, addressing a key gap in current management strategies.

This systematic review and network meta-analysis analyzed 16 randomized controlled trials involving 1,685 patients with adenomyosis to compare the efficacy of HIFU combined with various medications against HIFU alone. Researchers retrieved studies from 8 databases up to June 2025, assessing quality and bias using Cochrane 5.1 and RoB2. Six intervention groups were compared: HIFU + GnRH-a, HIFU + testosterone propionate, HIFU + percutaneous ethanol injection, HIFU + microbubble contrast agent, HIFU + oxytocin, and HIFU + microbubble contrast agent + oxytocin. Primary endpoints included non-perfused volume ratio (NPVR), sonication energy, treatment duration, and energy efficiency factor.

Compared to HIFU alone, combination therapies significantly improved intraoperative indicators for adenomyosis. HIFU combined with ethanol ablation demonstrated the highest efficacy across several key metrics. This combination increased non-perfused volume ratios (NPVR) by a Mean Difference (MD) of 27 (95% Confidence Interval (CI): 2.7 to 52). It also substantially reduced sonication energy by MD = -230% (95% CI: -290 to -180) and treatment duration by MD = -44% (95% CI: -80 to -7.8).