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

Abstract / Summary

Uterine fibroids (UFs) substantially affect the health of women of reproductive age. Minimally invasive and noninvasive therapies have become the main alternatives to traditional surgery; however, evidence on their comparative efficacy remains fragmented. This network meta-analysis compared high-intensity focused ultrasound (HIFU), radiofrequency ablation (RFA), microwave ablation (MWA), and uterine artery embolization (UAE) with myomectomy (Myo) for symptomatic UFs. Eight databases were searched (Jan 2016-Dec 2025) for randomized controlled trials (RCTs). ROB 2.0 and Stata 15.1 were used to analyze fibroid volume, recurrence counts, luteinizing hormone [LH], follicle-stimulating hormone [FSH], estradiol [E2], and adverse events using surface under the cumulative ranking curve (SUCRA) values, weighted mean differences (WMDs), and 95% confidence intervals (95% CIs). Thirty-one RCTs (2622 patients) were included. HIFU ranked highest for fibroid volume reduction (SUCRA = 96.7%; vs UAE: WMD = 10.31, 95% CIs: 3.52-17.10; vs RFA: WMD = 3.66, 95% CIs: 1.71-5.61) and recurrence prevention (SUCRA = 70.1%). Fluctuations in ovarian function indicators across therapies were clinically acceptable. HIFU ranked first for stabilizing LH (SUCRA = 58.4%) and FSH (SUCRA = 68.4%), whereas UAE ranked first for E2 stability (SUCRA = 77.0%). For safety, MWA (SUCRA = 78.8%) and HIFU (SUCRA = 69.7%) had the lowest incidence of adverse events. HIFU showed overall efficacy advantages, MWA showed a safety advantage, and UAE may suit specific patient populations. This study provides evidence-based support for individualized treatment decisions for UFs. However, these findings require cautious interpretation due to limited evidence. PROSPERO (CRD420251273503).

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