To investigate the efficacy and safety of magnetic resonance-guided focused ultrasound surgery (MRgFUS) ablation for abnormal uterine bleeding (AUB) due to uterine leiomyoma or adenomyosis.In total, thirty patients with AUB due to uterine leiomyoma (AUB-L group) or adenomyosis (AUB-A group) were treated by MRgFUS ablation. After MRgFUS ablation, the short-term clinical efficacy within one year was assessed.Sixteen patients were classified into the AUB-L group and 14 patients into the AUB-A group. The average nonperfused volume (NPV) ratios of the AUB-L and AUB-A groups were 82.7% ± 13.6% and 83.3% ± 11.1%, respectively. Compared with the baseline, the lesion volumes in the AUB-L and AUB-A groups were reduced by 45.6% and 34.6%, respectively, at 3 months after MRgFUS ablation. The hemoglobin concentration was increased by 22.4% in the AUB-L group and 15.3% in the AUB-A group at 3 months posttreatment. No amenorrhea occurred during the 12-month follow-up. The duration of bleeding decreased significantly in the AUB-A group. The mean PBAC scores at 3, 6 and 12 months posttreatment were reduced by 50.8%, 48.4% and 42.8%, respectively, in the AUB-L group and by 50.9%, 53.8% and 47.9%, respectively, in the AUB-A group. Compared with the baseline, at 3, 6 and 12 months posttreatment, the HRQL score increased by 41.5%, 43.3% and 33.3%, respectively, in the AUB-L group and by 24.7%, 31.1% and 28.2%, respectively, in the AUB-A group.MRgFUS is an effective and safe noninvasive uterine-sparing treatment modality in the management of AUB-L and AUB-A. MRgFUS can target lesion for ablation effectively, remove the factors that lead to AUB, retain a normal menstrual cycle, relieve AUB symptoms significantly and improve quality of life.AJTR Copyright © 2022.