HIFU for fibroids & adenomyosis

Fibroids: HIFU may suit intramural, subserosal and selected submucosal fibroids, whether single or multiple, when the lesion is at least 2 cm and has a safe ultrasound path. It is worth considering if heavy or prolonged periods, anaemia, pelvic pressure, urinary frequency or constipation affect you, or if you want to preserve your uterus or have fibroids after a previous myomectomy.

Adenomyosis: Both focal adenomyoma and diffuse adenomyosis can be assessed for HIFU, with relief of painful or heavy periods and chronic pelvic pain as the goal. It may also be an option if medication is hard to tolerate or a Mirena device has been expelled. Your doctor can use your imaging and symptoms to advise whether HIFU suits you.

HIFU is not suitable during pregnancy, with an active pelvic or genital infection, or when bowel or bone blocks a safe ultrasound path. A lesion suspicious for cancer needs investigation first.

Severe bleeding disorders, serious liver or kidney disease, inability to stay in the required position or communicate during treatment, and some implanted devices can also rule it out or require preparation. Tell the team about any IUD, pacemaker or breastfeeding. Your doctor can confirm which of these applies to you.

Fibroids: HIFU can ease heavy or prolonged periods and pressure symptoms such as pelvic fullness, lower back discomfort, urinary frequency and constipation. Anemia may improve as bleeding falls, though it may also need separate treatment.

Adenomyosis: HIFU can relieve painful or heavy periods, chronic pelvic pain and pain during sex. Some patients also see a reduction in uterine size. Your doctor can tell you which symptoms are most likely to improve in your case.

Fibroids (from better to more challenging candidates): Intramural and broad-based subserosal fibroids often respond well. With multiple fibroids, treatment can focus first on the larger lesions causing symptoms. Fibroids that appear after laparoscopic or open myomectomy are also worth assessing, since HIFU does not require another abdominal operation; the scar and ultrasound path still need checking. For 5–10 cm fibroids, GnRH-a may be used first to reduce size; those over 10 cm may be assessed for treatment in stages. Small, thin-stalked submucosal fibroids under 3 cm are often better treated by hysteroscopy.

Adenomyosis: A well-defined focal adenomyoma is easier to target; for diffuse adenomyosis, the goal is symptom relief rather than complete removal. Treatment may reduce uterine size and may help with Mirena retention. Cellular, T2-bright or very vascular fibroids are more challenging and may need medication beforehand. Your doctor can assess the likely response from your imaging.

HIFU treats the fibroid without an abdominal incision and preserves the uterus. Laparoscopic or open myomectomy removes the fibroid and also preserves the uterus, but new fibroids can develop and symptoms can return after either operation. HIFU can also need further treatment if symptoms persist or return.

The practical differences are whether the fibroid is ablated or removed, whether an incision is needed, and the recovery and risks of each approach. Hysterectomy removes the uterus and therefore the possibility of future uterine fibroids, but it is a different decision from choosing between HIFU and myomectomy. Your doctor can compare these options for your lesions and priorities.