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To investigate the clinical efficacy of magnetic resonance-guided focused ultrasound surgery (MRgFUS) ablation for adenomyosis after gonadotropin-releasing hormone agonist (GnRH-a) pretreatment.

From May 2017 to April 2018, twenty patients with symptomatic adenomyosis were underwent MRgFUS treatment. Before MRgFUS ablation, all patients were pretreated with GnRH-a. After ablation, the short-term clinical efficacy were assessed.

After GnRH-a therapy, the average volumes of the uterus and adenomyosis were reduced 48.3% and 47.9%, respectively, and the average signal intensity(SI) ratio of adenomyotic lesions decreased by 29.2%. After MRgFUS ablation, contrast-enhanced MRI showed an average nonperfused volume (NPV) ratio of 82.4±11.5%. Nine patients (45.0%) had 15 class A or B complications according to the Society of Interventional Radiology. Three months after MRgFUS treatment, the volumes of the uterus and adenomyosis were reduced by 20.4% and 36.9%, respectively, compared with baseline. Compared with baseline, the dysmenorrhea scores and PBAC scores significantly decreased at 3 months and 6 months after MRgFUS treatment.

MRgFUS ablation is feasible, safe and effective for patients with adenomyosis. GnRH-a pretreatment can significantly decrease the SI and volume of adenomyotic lesions and may create favorable conditions for subsequent MRgFUS ablation.

GnRH-a pretreatment can create favorable conditions for subsequent MRgFUS treatment, it is recommended that MRgFUS combined with GnRH-a as a recommended protocol for adenomyosis ablation.