OBJECTIVES: To evaluate the safety and effectiveness of conservative surgical treatments for uterine fibroids in women who wish to preserve their uterus. METHODS: A systematic literature search of electronic databases (MEDLINE, EMBASE, CENTRAL) and grey literature up to October 2012 identified 5 RCTs (436 patients): 2 comparing uterine artery embolization (UAE) with myomectomy (MYO) and 3 comparing UAE with laparoscopic uterine artery occlusion (LUAO). Primary outcome measures included patients’ satisfaction, re-intervention and ovarian failure rate. Secondary outcomes were clinical failure, hysterectomy and complication rates, hospitalization and recovery times, pregnancy rate, pregnancy complications and live-birth rate. Standard and network meta-analysis were performed on relevant outcomes. RESULTS: Of the three most popular uterine-sparing surgical treatments for fibroids, network meta-analysis showed that MYO and UAE resulted in higher rates of patient satisfaction and lower rates of clinical failure than LUAO in the first year after treatment [OR 2.56, 95%CrI 0.56- 11.75, P(better)=11% and 2.7, 95%CrI 1.1- 7.14, P(better)=1%; 0.29, 95%CrI 0.06- 1.46, P(better)=7% and 0.37, 95%CrI 0.13- 0.93, P(better)=2% respectively]. Moreover, MYO resulted in lower re-intervention and hysterectomy rates than UAE and LUAO [0.08, 95%CrI 0.02- 0.27, P(better)<1%, 0.08, 95%CrI 0.01- 0.37 P(better)<1%); 0.16, 95%CrI 0.01-0.85 P(better)=2%, 0.15 95%CrI 0- 8.74 P(better)=16% respectively] even though the later techniques had an advantage over MYO due to shorter hospitalization and quicker recovery. There was no evidence of convincing difference between the three techniques in the number of women experiencing ovarian failure, minor or major complications. However, MYO may lead to better conception outcomes in comparison to UAE (pregnancies: 3.44, 95%CI 1.18- 10.03; live-births: 3.02, 95%CI 1.00- 9.09). CONCLUSIONS: LUAO is less effective than UAE and MYO in the treatment of symptomatic fibroids for women who want to preserve their uterus. The choice between UAE and MYO should be based on individuals’ short and long-term expectations.