Systematic review with network meta-analysis: efficacy and safety of minimally invasive interventions for symptomatic uterine fibroids.

TL;DR

A network meta-analysis of 31 RCTs comparing minimally invasive therapies for symptomatic uterine fibroids found that HIFU achieved superior fibroid volume reduction and recurrence prevention, while MWA and HIFU had the lowest adverse event rates. Overall, treatment selection should be individualized based on efficacy and safety priorities.

Key findings

• HIFU ranked highest for fibroid volume reduction and recurrence prevention compared to UAE and RFA, with clinically meaningful differences (WMD 10.31 and 3.66 respectively)
• MWA and HIFU demonstrated the lowest incidence of adverse events (SUCRA 78.8% and 69.7%)
• Hormonal fluctuations (LH, FSH, E2) across all therapies remained clinically acceptable
• Evidence quality was limited; findings require cautious interpretation for clinical application

Why this matters at the bedside

Provides comparative efficacy and safety data for shared decision-making when selecting minimally invasive treatments for symptomatic uterine fibroids; supports tailored approach based on individual patient priorities and fibroid characteristics.