This scenario may be, sometimes, confusing; a common misconception is to consider these treatments as exclusive competitors in contrast with each other: On the contrary, they should be regarded as alternative therapeutic options with specific strengths and shortcomings, and the gynecologist should be familiar with the characteristics of each one, in order to provide a personalized therapy. The purpose of this work is to describe the main available uterus-sparing strategies for the management of symptomatic fibroids, as well as to provide a practical guide for the choice of the most appropriate option.