Transvaginal Radiofrequency Ablation for Symptomatic Uterine Fibroids

Key Takeaways

• Across contemporary observational studies, substantial 12-month fibroid shrinkage and improvement in reported symptom burden were observed after treatment.
• Reintervention was pooled at 10.5% (95% CI, 5.2% to 19.8%), and major complications were rare.
• Reproductive data were sparse and heterogeneous; no uterine rupture was reported, and certainty across outcomes was very low.

A Journal of Minimally Invasive Gynecology systematic review and meta-analysis evaluated transvaginal radiofrequency ablation for symptomatic uterine fibroids and found a pooled 12-month volumetric reduction of 72.4% (95% CI, 58.1% to 86.7%). Symptom measures also improved across pooled analyses. Major complications were uncommon in the included cohorts during available follow-up. Reproductive outcomes were less consistently reported, and the evidence remained limited and heterogeneous.

The analysis pooled seven observational studies involving 616 women, published from January 2020 through August 2025. The studies included reproductive-age and perimenopausal women with symptomatic fibroids who underwent ultrasound-guided transvaginal radiofrequency ablation and had at least 6 months of follow-up. The review followed PRISMA 2020 and included PROSPERO registration CRD420251174700. No randomized trials were identified, and most data came from single-arm cohorts comparing outcomes before and after treatment within the same study populations. Random-effects models using REML with Hartung-Knapp adjustment were used for pooled estimates of effectiveness, reintervention, and adverse events, while reproductive outcomes were synthesized descriptively because denominator data were limited.

Most efficacy estimates centered on 12-month assessments, the main pooled window for volume and symptom outcomes. Two studies contributed complete symptom data, with a mean Symptom Severity Score reduction of 9.8 points at 12 months. Reintervention occurred in a minority of patients, although excluding the largest study increased the pooled estimate to 15% in sensitivity analysis. Exploratory meta-regression did not show a significant association between baseline fibroid volume and response magnitude. Overall, pooled results showed symptom and volume improvement over short-to-medium-term follow-up in these observational cohorts.

Safety findings showed few serious events, and major complications were rare across procedure and follow-up reports. When adverse events were detailed, most were mild. ROBINS-I showed moderate to severe risk-of-bias concerns, and Newcastle-Ottawa Scale ratings were generally moderate to good across studies. Reproductive data were scarce and heterogeneous, and one study with an adequate denominator reported pregnancy in 14 of 19 women attempting conception, or 73.7%. No cases of uterine rupture were reported, and limited denominator availability prevented broader pooled estimates for fertility outcomes.

GRADE certainty across outcomes was very low, reflecting observational-only evidence, the absence of randomized trials, and the small number of studies. The authors also cited heterogeneity, imprecision, and limited statistical power as important constraints on the pooled estimates. The search was restricted to 2020 onward to reflect contemporary practice, and some cohorts extended follow-up to 24 or 36 months. Overall, pooled data showed symptom and volume improvement over short-term to medium-term follow-up after transvaginal radiofrequency ablation, while longer-term durability and reproductive outcomes remained uncertain.