Objective：To investigate the effect of HIFU treatment for uterine fibroids and adenomyosis on coagulation indicators. Design：Retrospective cohort study. Setting：Shanghai First Maternal and Infant Hospital. opulation or Sample：1189 patients diagnosed with uterine fibroids or adenomyosis who received HIFU treatment from August 2015 to November 2020. Methods：Paired t-tests were applied on coagulation indicators measured before and after HIFU treatment. Using multiple logistic regression models, adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported to evaluate the association between the risk of upgraded D-dimer / fibrinogen degradation products (FDP) and HIFU treatment parameters categorized into tertiles. Main Outcome Measures：Elevated D-dimer (>1.0 mg/L) and FDP levels (>5 μg/mL), and follow-up for thromboembolism according to lower extremity vein ultrasonography and computer tomography pulmonary angiography. Results：1148 eligible patients were included in the analysis. After HIFU treatment, 61.8% and 55.7% of patients exhibited elevated D-dimer and FDP levels, respectively, and 54.6% had simultaneous elevation of both on the first day after HIFU treatment. Other post-treatment coagulation indicators also revealed a hypercoagulable state, including prolonged PT and TT, shortened APTT, and decreased PLT. During follow-up, no patients manifested thromboembolism. Multiple HIFU parameters were associated with elevated D-dimer and FDP. The highest tertile group of exposure energy was notably associated with a higher risk of simultaneous elevation of both D-dimer and FDP (adjusted OR [95% CI]: 4.58 [3.17, 6.66]). These associations were consistent among fibroid and adenomyosis groups. Conclusions：Higher exposure energy in HIFU treatment induce coagulation function changes, leading to a hypercoagulable state post-treatment.