Two-Year Clinical Outcomes of Transvaginal Radiofrequency Ablation for Symptomatic Uterine Fibroids: A Retrospective Observational Study

<b>Background:</b> Transvaginal radiofrequency ablation (TRFA) is a minimally invasive, uterus-preserving technique for symptomatic uterine fibroids. This study evaluates its two-year clinical and volumetric outcomes, safety profile, patient satisfaction, and reintervention rates. <b>Methods:</b> In this single-center, retrospective, single-arm observational cohort study, 121 premenopausal women underwent outpatient TRFA under general anesthesia between 2018 and 2023. Follow-up visits at 1, 6, 12, and 24 months assessed fibroid volume reduction, symptom improvement using the Uterine Fibroid Symptom and Quality of Life Questionnaire (UFS-QoL), vascularity, satisfaction, complications, and the need for reintervention. A total of 169 fibroids were treated. <b>Results:</b> TRFA resulted in progressive fibroid shrinkage, with a mean volume reduction of 57.97% at 6 months and 60.75% at 24 months, accompanied by sustained improvement in UFS-QoL scores (from 30.19 at baseline to 14.97 at 24 months). Patient satisfaction was high (96.61%). Complications were infrequent and predominantly mild, and recovery was rapid, with short postoperative analgesia (mean 2.87 days) and limited sick leave (mean 3.34 days). The two-year reintervention rate was 24.79%, with a substantial proportion corresponding hysteroscopic procedures planned a priori as part of a sequential therapeutic strategy. Among 22 pregnancies recorded after TRFA, 81.82% resulted in term deliveries with favorable neonatal outcomes although fertility was not a predefined study endpoint. <b>Conclusions:</b> TRFA appears to be a safe, effective, and well-tolerated minimally invasive treatment for symptomatic uterine fibroids, offering durable symptom relief and significant volume reduction and rapid recovery, and encouraging reproductive outcomes. Within the limitations of its single-arm observational design, these results support TRFA as a valuable uterus-preserving therapeutic option.