Objective <p>To assess the advantages of High-Intensity Focused Ultrasound (HIFU) in the treatment of uterine leiomyomas and adenomyosis.</p> Methods <p>Patients with uterine leiomyomas (435 cases) and adenomyosis (78 cases) treated in our hospital from March 2020 to October 2023 were selected to receive non-invasive treatment with HIFU. Clinical symptom improvement and fibroid shrinkage were observed, and the incidence of complications and adverse reactions during and after treatment were analyzed.</p> Results <p>The success rate of HIFU treatment in 435 cases of uterine leiomyomas was as high as 94.71%. The success rate of HIFU treatment was 96.15% in 78 cases of adenomyosis. Compared with before treatment, the improvement of clinical symptoms and the reduction of leiomyomas at one month, three months and six months after treatment were relatively better than those at the treatment period (<i>P</i> &lt; 0.05). There were no serious adverse reactions in the patients during the treatment.</p> Conclusion <p>The noninvasive application of HIFU on leiomyomas and adenomyosis effectively improves the clinical symptoms of patients, and the volume of fibroids decreases significantly. At the same time, HIFU is safe and worthy of clinical application.</p> Graphical abstract <p></p>