<h3>Study Objective</h3> To demonstrate the use of a transcervical radiofrequency ablation (RFA) device approved for symptomatic uterine fibroids as a possible treatment for adenomyosis. <h3>Design</h3> A case report. <h3>Setting</h3> Community hospital affiliate of a large university hospital. <h3>Patients or Participants</h3> 35-year-old gravida-2 para-0 female with uterine fibroids and infertility, presenting with heavy menstrual bleeding, dysmenorrhea, and recent 1<sup>st</sup> trimester miscarriage. Pelvic MRI showed a 12 cm uterus with a 2 cm endometrial polyp, 4.5 cm pedunculated fundal fibroid, and diffusely thickened posterior and fundal myometrium consistent with adenomyosis. <h3>Interventions</h3> The patient desired uterine-sparing surgical management and underwent a laparoscopy, hysteroscopy and transcervical RFA. <h3>Measurements and Main Results</h3> Laparoscopically, extensive posterior adenomyosis, a 4.5 cm pedunculated fibroid, and sub-centimeter exophytic fibroid were noted. Endometriosis and small left ovarian fibromas were incidentally diagnosed. Hysteroscopically, there was a 2 cm endometrial lesion with an otherwise normal endometrial cavity. The patient underwent laparoscopic myomectomy of 2 fibroids (without myometrial incision), excision of left ovarian fibromas, and excision of endometriosis in 2 areas, as well as hysteroscopic resection of the endometrial lesion. Ultrasound-guided transcervical RFA then targeted the thickened posterior myometrium with ablation of two adenomyotic regions (measuring 3.4 × 2.6 cm and 3.8 × 2.6 cm). Outgassing was visualized on intrauterine ultrasound images in these regions similar to ablated uterine fibroids and suggestive of successful adenomyosis ablation. Concomitant laparoscopy confirmed no thermal spread beyond uterine serosa. The patient was discharged home the same day. Final pathology revealed fibroids, endometriosis, ovarian spindle cell tumor, and products of conception. On follow-up evaluation, she had no postoperative complaints and no pain medication requirements beyond the immediate postoperative period. Assessment of long-term symptomatic improvement and fertility outcomes are ongoing. <h3>Conclusion</h3> Transcervical radiofrequency ablation is a promising uterine-sparing treatment for patients with adenomyosis. Additional research is warranted to assess long-term symptom improvement and pregnancy outcomes.