Purpose of Review: To introduce recent developments in a noninvasive treatment of using high-intensity focused ultrasound (HIFU) for ablating uterine localized adenomyosis, and to discuss their potential in this application. Recent Findings: This literature roughly reviewed conservative therapy for uterine localized adenomyosis and emphasized using HIFU for ablating it. The main histological change of HIFU treatment was the coagulative necrosis of adenomyosis cells, with damage on small blood vessels of adenomyoma. MR-guided focused ultrasound surgery (MRgFUS) and ultrasound-guided HIFU ablation of focal adenomyosis were with satisfactory results. MRgFUS was less invasive and safely ablated adenomyosis tissue close to the endometrium or to serosal surface. HIFU might be safe and effective for treating patients with adenomyosis, and the acoustic intensity was a key factor for therapeutic efficacy as the severity of symptoms might correlate with lesion extent in some patients. At a given therapeutic dose, the influence of acoustic intensity on focal temperature rise was greater than that of exposure time. Some other experiments showed that the size of adenomyoma was increased 3-4 months after HIFU treatment. The reasons were related to the size of tumor, treatment parameters, operation procedure, and the blood supply of the targeted tissue. Although recent results have been very encouraging, further trials are essential to evaluate the long-term efficacy, and cost-effectiveness of HIFU ablation in localized adenomyosis. Summary: Compared with current conservative treatments, HIFU may be a noninvasive approach and may offer complete ablation of adenomyoma, with less trauma, less complication, and low cost and short hospital stay for treating patients with uterine localized adenomyosis. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.