It is very important to treat
adenomyosis which may cause
infertility,
menorrhagia, and
dysmenorrhea for women at the reproductive age. High-intensity focused ultrasound (HIFU) is effective in destroying target
tumor tissues without damaging the path of the ultrasound beam and surrounding normal tissues. The
levonorgestrel-releasing intrauterine system (LN-IUS) is a medical system which is inserted into the uterine to provide medicinal treatment for temporary control of the symptoms caused by
adenomyosis. This study was to investigate the effect of HIFU combined with the LN-IUS on
adenomyosis. In the HIFU treatment, the parameters of the ultrasound were transmission frequency 0.8 MHz and input power 50-400 W (350 ± 30), and the temperature in the target tissue under these conditions would reach 60-100 °C (85 °C ± 6.3 °C). Size reduction and blood flow signal decrease were used to assess the effect of combined treatment. In this study, 131 patients with
adenomyosis treated with HIFU combined with LN-IUS were retrospectively enrolled. The clinical and follow-up data were analyzed.
After treatment, the volume of the uterine lesion was significantly decreased with an effective rate of 72.1%, and the
adenomyosis blood flow signals were significantly reduced, with an effective rate of 71.3%. At six months, the menstrual cycle was significantly (P < 0.05) decreased from 31.4 ± 3.5 days before treatment to 28.6 ± 1.9 days, the menstrual period was significantly shortened from 7.9 ± 1.2 days before HIFU to 6.5 ± 1.3 days, and the menstrual volume was significantly (P < 0.05) decreased from 100 to 49% ± 13%. The serum
hemoglobin significantly (P < 0.05) increased from 90.8 ± 6.2 g/L before treatment to 121.6 ± 10.8 g/L at six months for patients with
anemia. Among seventy-two (92.3%) patients who finished the six-month follow-up, sixty-five (90.3%) patients had the
dysmenorrhea completely relieved, and the other seven (9.7%) patients had only slight
dysmenorrhea which did not affect their daily life. Adverse events occurred in 24 (18.3%) patients without causing severe consequences, including skin
burns in two (1.5%) patients, skin swelling in four (3.1%), mild lower
abdominal pain and low
fever in 15 (11.5%), and subcutaneous induration in three (2.3%). Six months
after treatment, no other serious side effects occurred in any patients with follow-up. In conclusions, the use of high-intensity focused ultrasound combined with the
levonorgestrel-releasing intrauterine system for the treatment of
adenomyosis is safe and effective even though the long-term effect remains to be confirmed.