Abstract Background Uterine fibroids are common gynecological conditions that affect a significant number of women of reproductive age and may necessitate surgical intervention for their removal. However, there is a rising trend toward minimally invasive procedures, such as magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) ablation. This report provides the first experience in Egypt and North Africa on the use of MRgHIFU ablation as a therapeutic option for uterine fibroids. Results This study demonstrates a correlation between post-operative NPV% and symptom improvement. Following a three-month follow-up period, a significant reduction in pain scores and excessive bleeding was observed. Importantly, there was no significant elevation in hemoglobin levels (11.23 ± 2.23 to 11.25 ± 1.71 g/dL) after treatment. Furthermore, the mean non-perfused volume ratio in the treated fibroids was 46 ± 27.3% (SD) among the 20 participants. These findings suggest a favorable therapeutic outcome of MRgHIFU, with no serious adverse effects reported. Conclusion MRgHIFU is a noninvasive therapeutic approach for the treatment of uterine myomas, offering significant benefits in terms of pain reduction and improved quality of life. This particular study represents the pioneering clinical experience of this innovative therapy in Egypt.