Objective: To demonstrate the efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) in uterine fibroid treatment in terms of extension of non-perfused volume and improvement of the symptoms above all in fertile women. This method is a valid alternative to hysterectomy. Materials and Methods: From October 2011 to September 2015, 78 patients, aged between 23 and 51 years, affected by uterine fibroids, were treated with MRgFUS in the present department. The authors included 47 patients affected only by uterine fibroids (size range 2- 14 cm) and 31 affected by multiple fibroids. Symptoms were dysmenorrhea, menorrhagia, and infertility. Symptomatology was assessed through the symptoms severity score questionnaire. The authors evaluated the radicalization of the treatment measuring the non-perfused volume (NPV) on the c.e. T1–weighed sequences immediately after the treatment and compared these results with the pre-treatment volume of the fibroids. A dedicated informatics measurement system was used. Results: The present results showed a mean of non-perfused volume of 78%, with a good radicalization of the treatment. Patients presented a marked reduction of symptoms (90%) when compared to pre-treatment. Conclusion: The treatment of uterine fibroids using MRgFUS is a valid alternative to surgery. A good extension of the necrotic area is obtained in women affected by multiple and single fibroids, maintaining the integrity of the uterus.