Objective The purpose of this meta-analysis was to compare the effectiveness and safety of HIFU with surgical interventions for the treatment of symptomatic uterine fibroids in women according to the studies available in current literature. Main results A total of 10 studies involving 4450 women were included in our meta-analysis. Compared with surgery group, the reduction of uterine fibroid symptom (UFS) scores at 6- and 12-month follow-up were higher in HIFU group, with the overall MD -4.16 (95% CI, -7.39 to -0.94, P=0.01) and -2.44 (95% CI, -3.67 to -1.20, P=0.0001), respectively. The increase of quality-of-life (QoL) scores at 6- and 12-month follow-up were also higher in HIFU group, with the overall MD 2.13 (95% CI, 0.86 to 3.14, P=0.001) and 2.34 (95% CI, 0.82 to 3.85, P=0.003), respectively. Both of the duration of hospital stay and the time to return to work was significantly shorter in HIFU group, with the overall MD -3.41 (95% CI, -5.11 to -1.70, P<0.0001) and -11.61 (95% CI, -19.73 to -3.50, P=0.005), respectively. The incidence of significant complications was significantly lower in HIFU group, with the overall RR 0.33 (95% CI, 0.13 to 0.81, P=0.02). The difference of incidence of adverse events, effective rate, symptom recurrence rate, re-intervention rate and pregnancy rate between HIFU and surgery were not statistically significant. Conclusion Compared with surgical interventions, HIFU ablation therapy leads to more significant alleviation of symptoms and improvement of QoL, quicker postoperative recovery and fewer significant complications.