HIFU Versus Myomectomy for the Treatment of Symptomatic Uterine Fibroids

Inclusion Criteria: * Age 18 - 50 years-old * Pre or peri menopausal with FSH less than 25 mIU/ml * BMI \< 33 kg/m2 or abdominal wall thickness \< 5 cm * Uterine size ≤18 weeks based on physical exam assessment * Dominant intramural fibroid ≥ 3cm and ≤ 10cm on imaging * Symptomatic fibroids cause menorrhagia, pressure, or pelvic pain * Willing and able to give informed consent Exclusion Criteria: * Patient with other pelvic mass indicated by history or magnetic resonance imaging (MRI) such as endometriosis, abnormal adnexal mass, ovarian tumor, acute or chronic pelvic inflammatory disease * Morbid obesity * Inability to lie in a prone position for more than 2 hours * Extensive abdominal scar on the acoustic channel * Women with pregnancy, lactation or menopause * Uterine premalignant or malignant pathologies or pathology other than uterine fibroid cannot be ruled out through detailed clinical assessment and investigation including MRI * Rapid growth of fibroids, defined as a doubling in size in 6 months * History of or current thromboembolic event (deep vein thrombosis, pulmonary embolus, stroke) * Coagulation problem or using medication which affect clotting function * History of pelvic irradiation * Pedunculated submucosal or subserosal fibroid of size ≧5cm and with a stalk less than 25% of the maximal fibroid diameter * Cervical/ broad ligament fibroid * Contraindication to MRI due to severe claustrophobia or implanted metallic device. * Co-existing adenomyosis