Objectives: The purposes of this study were to determine the feasibility of transvaginal uterine artery ligation as a conservative minimally invasive treatment for symptomatic uterine fibroids, and to evaluate the efficacy of transvaginal uterine artery ligation on symptoms of leiomyoma and the ultrasound features of leiomyoma. Design: This study was designed as a prospective clinical study. Materials and methods: Twenty women of reproductive age with symptomatic uterine fibroids, wanting conservative surgical management, were recruited for the study from the outpatient clinic at Guru Teg Bahadur Hospital, Delhi, India. Transvaginal uterine artery ligation was performed with the patient under anesthesia. The patients were followed up at 1, 3, and 6 months for persistence or recurrence of symptoms, clinical examination, and transvaginal ultrasonography. Results: At 6 months, there was a statistically significant decrease in the following measured outcomes: menstrual blood loss (40.16%); dysmenorrohea (66%); dyspareunia (75%); low backache (65%); fibroid volume (25%); and uterine volume (19%). Conclusions: Transvaginal uterine artery ligation was found to be a safe, efficacious, feasible, and cost-effective procedure with good patient-satisfaction rates with the conservative approach for treating uterine myomas. ( J GYNECOL SURG 27:225)