Objective: To explore the effectiveness of high-intensity focused ultrasound (HIFU) ablation in patients with adenomyosis who have experienced treatment failure with conservative methods. Methods: Patients diagnosed with adenomyosis at the Department of Obstetrics and Gynecology of the People's Hospital of Guangxi Zhuang Autonomous Region from October 2020 to April 2022, who had experienced recurrent adenomyosis and were willing to undergo HIFU treatment were included in this study. Real-time ultrasound was used to determine the target area during the HIFU ablation process, and ultrasound contrast imaging was performed immediately before and after treatment to evaluate the ablation rate. Dysmenorrhea symptoms were collected before treatment and at 3, 6, 12, and 24 months after treatment, and the percentage of pain relief was calculated. Pain relief lasting more than 6 months after the operation was considered effective, while the recurrence of moderate or severe dysmenorrhea was classified as recurrence. Results: A total of 92 patients were included in this study, with an average ablation rate of 76.67±6.22% immediately after HIFU treatment as indicated by ultrasound imaging. Dysmenorrhea relief rates at 3, 6, 12, 18, and 24 months post-treatment were 88.04%, 75.00%, 55.43%, 42.86%, and 32.97%, respectively. Conclusion: HIFU treatment is safe and effective for patients with adenomyosis who experience recurrence of dysmenorrhea after conservative treatment. It has a high short-term efficacy rate and can be considered a treatment option for young patients who wish to preserve their uterus.