Traditionally, the treatment of choice for uterine fibroids has been watchful waiting or surgery. Recently, thermal ablation of uterine fibroids has been shown to be an effective alternative treatment. One of these ablation techniques, high intensity focused ultrasound (HIFU) which allows radiation-free treatment, has been used for the treatment of uterine fibroids. The aim of this study was to observe the efficacy and safety of HIFU used for the treatment of uterine fibroids. Fifty-two patients with uterine fibroids were treated with HIFU with ultrasound guidance. Clinical outcomes, ultrasound results, improvement of symptoms, and complications were reviewed. Follow up evaluations were obtained, when possible, at 3, 6, 12, 24, 36 months after HIFU therapy (mean, 20 months). Symptoms were improved in all patients. Seventy-nine percent (41/52) of the treated patients showed either obvious or partial improvements in their symptoms. After HIFU treatment, blood flow in the uterine fibroids was reduced or was even completely blocked judging from imaging examinations. All uterine fibroids decreased in volume at a few months to three years after treatment. No severe complications were observed after HIFU ablation. The only complication was skin burn, which was usually resolved with conservative treatment. Two women underwent hysterectomies during the follow-up period. This study demonstrates that ultrasound-guided HIFU can be a valuable therapy for women with uterine fibroids.