The 1990 film The Handmaid's Tale was based on a screenplay by Harold Pinter and directed by Volker Schlöndorff. It starred Natasha Richardson as Offred, Faye Dunaway as Serena Joy, and Robert Duvall as The Commander (Fred).
A dramatic adaptation of the novel for radio was produced for BBC Radio 4 by John Dryden in 2000.
An operatic adaptation, The Handmaid's Tale, by Poul Ruders, premiered in Copenhagen on 6 March 2000, and was performed by the English National Opera, in London, in 2003. It was the opening production of the 2004–2005 season of the Canadian Opera Company.
A stage adaptation of the novel, by Brendon Burns, for the Haymarket Theatre, Basingstoke, England, toured the UK in 2002.
A ballet adaptation choreographed by Lila York and produced by the Royal Winnipeg Ballet premiered on 16 October 2013. Amanda Green appeared as Offred and Alexander Gamayunov as The Commander.