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OBJECTIVE Uterine fibroids are one of the most common gynaecological tumours in premenopausal women. The conventional surgical treatments are myomectomy and hysterectomy, but high-intensity focused ultrasound (HIFU) is a new noninvasive treatment creating no surgical wound. The aim of this study was to evaluate the effectiveness and safety of HIFU treatment compared with conventional surgery for patients with uterine fibroids. DATA SOURCES PubMed, Embase, and the Cochrane Library were searched for studies published before January 2021. METHODS OF STUDY SELECTION Studies comparing the outcome of HIFU and conventional surgery-myomectomy and hysterectomy-for patients with uterine fibroids were included. We conducted meta-analyses by using a random effects model. Uterine fibroid symptom score and the quality of life score were analysed using the weighted mean difference (MD). The recovery time and frequency of major adverse events were also evaluated. TABULATION, INTEGRATION, AND RESULTS Ten studies were included. HIFU relieved uterine fibroid symptom significantly when compared to conventional surgery at 6 (MD: -1.61, 95% confidence interval [CI]: -2.88 to -0.33) and 12 (MD: -2.44, 95% CI: -3.68 to -1.20) months after treatment. Similarly, HIFU group improve the quality of life score significantly at 6 (MD: 2.14, 95% CI: 0.86 to 3.42) and 12 (MD: 2.34, 95% CI: 0.82 to 3.86) months after treatment when compared with surgery group. CONCLUSION HIFU could be an effective and safe treatment option for patients with uterine fibroids. However, one of its side effects, skin burns, requires further research and discussion. Additional studies involving more randomized controlled trials are warranted.