Objective: To compare the clinical results of surgical and endovascular treatment of uterine myomas in young women. Study design: In a university-affiliated, tertiary care center a prospective trial was conducted. Sixty-three women, wishing to retain fertility, with intramural fibroid(s) larger than 4 cm, were randomly selected either for uterine artery embolization or myomectomy. Invasiveness, efficacy, and complications of both procedures were compared. Results: Thirty embolizations and 33 myomectomies (15 laparoscopic, 18 open) were performed. The mean follow-up was 17 months. In embolized patients, there was a significantly shorter procedure length (p < 0.0001), hospital stay (p < 0.001) and disability period (p < 0.0001), lower CRP (p < 0.001) and higher hemoglobin (p < 0.0001) concentrations the 2nd day after procedure. But there was a higher incidence of reinterventions (p < 0.01) and a lower rate of total symptomatic relief (p < 0.1). The groups did not significantly differ in: technical success rate, febrile morbidity, FSH levels 6 months after the procedure, and complication rates. Conclusions: Although the reproductive outcomes of uterine artery embolization and myomectomy cannot be evaluated at the moment, our first results indicate that both methods are clinically successful in the majority of cases and are not connected with significant number of serious complications. Study: To compare the clinical results of surgical and endovascular treatment of uterine myomas in young women. Study design: In a university-affiliated, tertiary care center a prospective trial conducted conducted. Sixty-three women, wishing to retain fertility, with intramural fibroid (s) larger than 4 cm, were randomly selected either for uterine artery embolization or myomectomy. Results: Thirty embolizations and 33 myomectomies (15 laparoscopic, 18 open) were performed. The mean follow-up was 17 months. In embolized patients, there was a significantly shorter procedure length (p <0.0001), hospital stay (p <0.001) and disability period (p <0.0001) (p <0.0001) concentrations the 2nd day after procedure. But there was a higher incidence of reinterventions (p <0.01) and a lower rate of total symptomatic relief (p <0.1). The groups did not significantly differ in: technical success rate, febrile morbidity, FSH levels 6 months after the procedure, and complication rates. Conclusions: Although the reproductive outcomes of uterine artery embolization and myomectomy can not be evaluated at the moment, our first results that that both clin clinically successful in the majority of cases and are not connected with significant number of serious complications.