high intensity focused ultrasound for endometriosis

High-intensity focused ultrasound (HIFU) is not currently established as a standard effective treatment for endometriosis in UK clinical guidelines. NICE guidelines for endometriosis recommend surgical treatment predominantly via laparoscopy, supplemented by hormonal and analgesic therapies for symptom control, with no mention of HIFU as a recognized option NICE NG73,NICE CKS.

However, recent systematic reviews and clinical case reports from the literature indicate that HIFU shows promise as a noninvasive therapeutic alternative for certain manifestations of endometriosis. Specifically, HIFU has been studied in the management of abdominal wall endometriosis (AWE) and rectosigmoid deep infiltrating endometriosis (DIE), with reported significant clinical efficacy including lesion volume reduction and symptom remission, although safety concerns such as pain, hematuria, and skin burns require careful patient selection and monitoring Ali et al. 2024Knorren et al. 2024.

Additionally, case reports demonstrate successful pregnancy outcomes following HIFU treatment of adenomyosis coexisting with endometriosis when combined with in vitro fertilization and hormonal downregulation, supporting HIFU as a fertility-preserving option in complex cases Wen et al. 2025. While these findings are encouraging, the data are derived mostly from observational studies and small cohorts without randomized controlled trials specifically comparing HIFU to established treatments Marques et al. 2020Wen et al. 2025.

Therefore, current high-quality evidence and guideline recommendations do not support routine use of HIFU for endometriosis, but ongoing research suggests it may become a valuable adjunct or alternative therapy for selected patients in the future, especially those seeking noninvasive options or fertility preservation Li et al. 2026Ali et al. 2024.