RADIOFREQUENCY ablation for adenomyosis showed encouraging reductions in lesion size and improvements in symptoms, according to findings presented by Elvin Piriyev, Academic Hospital Cologne Weyertal, Germany, during the Laparoscopy session at the ESGE 35th Annual Congress.
The presentation explored the use of transcervical, ultrasound-guided radiofrequency ablation, initially developed for uterine fibroids, to treat adenomyosis. The approach enabled clinicians to visualise affected tissue and deliver targeted treatment through the cervix without surgical incisions.
The device incorporated an ultrasound probe and displayed an ablation zone alongside a surrounding safety zone. Adjustable imaging angles supported positioning, while the system guided operators through successive treatment steps. These features were highlighted as advantages for targeting disease within the uterine wall.
In the presented cohort, mean focal adenomyosis lesion diameter decreased from 4.4 cm to 2.8 cm following treatment.
A separate case involved a 41-year-old patient with adenomyosis, severe symptoms, and a desire to preserve fertility, who declined hormonal treatment. At 6 months, follow-up imaging showed substantial reductions in uterine and adenomyosis volumes. The patient subsequently reported resolution of severe pain, regular menstrual cycles, and normalisation of bleeding intensity.
Piriyev emphasised that symptom relief, rather than imaging changes alone, was the principal outcome of interest. Follow-up hysteroscopy identified necrotic tissue within the uterine cavity, which was removed.
A further case involved cystic adenomyosis that had remained symptomatic despite previous treatment. At 6 months after ablation, the cyst was no longer visible, although the presenter described a possible residual area of scar tissue.
The presentation also discussed pregnancies and deliveries following radiofrequency ablation among patients with adenomyosis and a history of infertility. These outcomes highlighted interest in the technique as a potential uterus-preserving treatment for patients wishing to conceive.
Together, the cohort findings and individual cases suggested potential benefits for patients seeking symptom relief while retaining their uterus. Direct ultrasound visualisation and targeted treatment were presented as practical advantages of the transcervical approach.
However, Piriyev emphasised that radiofrequency ablation for adenomyosis remained experimental. Although the reported outcomes were encouraging, further evaluation was needed to establish its role in clinical practice, including its implications for fertility and longer-term symptom control.
Reference
Piriyev E. Radiofrequency ablation for adenomyosis: current evidence and clinical outcomes. Presentation. ESGE 35th Annual Congress, 4–7 October, 2026, Kraków, Poland.
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