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Transvaginal Radiofrequency Ablation for Symptomatic Uterine Fibroids: A Systematic Review and Meta-Analysis of
Gabriela Dalla Giacomassa Rocha Thomaz1, Luma Girardi Kautz1, Gabriela Pereira Macelaro2
1Obstetrics and Gynecology Service, Federal University of Health Sciences of Porto Alegre (UFCSPA) (Thomaz, Kautz, Vanin and Dibi), Porto, Alegre, Brazil; Department of Obstetrics and Gynecology, Santa Casa de Porto Alegre (Thomaz, Kautz, Vanin and Dibi), Porto Alegre, Brazil.
Objective:
To evaluate the efficacy, safety, and reproductive outcomes of transvaginal radiofrequency ablation (TV-RFA) for the treatment of symptomatic uterine fibroids.
Data Sources:
We selected articles published between January 2020 and August 2025 from PubMed/MEDLINE, Embase, Scopus, Cochrane Library, LILACS, and SciELO databases.
Methods Of Study Selection:
This systematic review followed the PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251174700). We included observational studies reporting clinical, radiological, or reproductive outcomes following TV-RFA. Data extraction was performed by 2 independent reviewers. Risk of bias was assessed using ROBINS-I and the Newcastle-Ottawa Scale.
Tabulation, Integration, And Results:
Seven studies (n = 616) were included. Analyses utilized random-effects models (REML) with Hartung-Knapp adjustment. The pooled volumetric reduction at 12 months was 72.4% (95% CI, 58.1-86.7%). Improvement in the Symptom Severity Score (SSS) showed a mean reduction of 9.8 points. The reintervention rate was 15% (95% CI, 5.2-19.8%). Major complications were rare. Meta-regression showed no association between baseline fibroid volume and response magnitude. Although scarce, reproductive data indicated a favorable safety profile, with successful pregnancies and no cases of uterine rupture reported.
Conclusion:
TV-RFA appears to be an effective, minimally invasive, uterine-sparing option, demonstrating significant volumetric reduction, consistent symptomatic improvement, and a low complication rate. While initial reproductive results are encouraging, robust prospective studies are needed to strengthen evidence regarding safety and fertility.
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