Microwave Ablation for Adenomyosis: A Narrative Review of Principles, Outcomes and Clinical Integration

Adenomyosis is a chronic, oestrogen-responsive uterine disorder characterised by endometrial glands and stroma within the myometrium. It is commonly associated with dysmenorrhoea, heavy menstrual bleeding, chronic pelvic pain, subfertility, and impaired quality of life. Increasing demand for uterine preservation has stimulated interest in image-guided thermal therapies as alternatives to hysterectomy. Microwave Ablation (MWA) produces rapid dielectric heating and coagulative necrosis within targeted adenomyotic tissue while aiming to preserve the endometrial cavity, serosal surface, and unaffected myometrium. The present narrative review summarises the biophysical basis, patient selection, imaging requirements, procedural principles, clinical outcomes, reproductive evidence, safety considerations, and comparative position of MWA. Published cohorts report substantial reductions in pain, bleeding, symptom-severity scores, and uterine or lesion volume. In a 36-patient study of posterior-wall adenomyosis, complete relief of dysmenorrhoea and menorrhagia at 12 months was reported in 81.3% and 69.6% of evaluable patients, respectively, with an 11.1% recurrence rate and no major complications. However, fertility evidence remains limited: MWA-specific pregnancy and live-birth rates cannot yet be estimated reliably, and pooled reproductive outcomes for imageguided thermal ablation combine several modalities. Uterine rupture after MWA has not been quantified and remains an unresolved obstetric safety question. MWA is therefore a promising uterus-preserving option for carefully selected patients, but standardised eligibility criteria, energy-delivery protocols, outcome definitions, and prospective long-term reproductive studies are required before it can be considered an established fertility-restoring treatment.