Currently, different treatment options are available in the management of uterine fibroids: Medical therapy aims at relieving symptoms, while semi-invasive or non-invasive procedures aim to treat symptoms and eventually to reduce the fibroids' size. A wide spectrum of treatments may be confusing to implement correctly, and the gynecologist should be familiar with the features of each procedure, to provide a personalized therapy, with each patient being directed towards the most suitable therapeutic option according to her specific characteristics. A thorough knowledge of the properties of each therapeutic strategy is fundamental for a correct orientation of the specialist in the management of symptomatic uterine fibroids; the final purpose has to be the establishment of an individual-centered care system, within each woman will be addressed by the most suitable among the available treatment options. This work provides a panoramic view of the main available uterus-sparing strategies for the management of symptomatic fibroids (with particular attention on specific indications, patient selection, advantages and adverse events), as well as a practical and comprehensive guide for the choice of the most appropriate option.