Objective To analysis complications and its associated risk factors of high intensity focused ultrasound (HIFU) in treatment of uterine leiomyoma for selecting rationale indicated patients and reducing complications. Methods Medical documents of 171 patients with 231 leiomyomas in total treated by HIFU were studied retrospectively. Common complications were categorized and analyzed, the relationship between risk factors and complications were studied. Results Common complications in treatment of uterine leiomyomas by HIFU were 71.9% (123/171) of abdominal pain, 17.5% (30/171) of vaginal bloody discharge, 8.2% (14/171) of sacroiliac or buttock pain, 7. 6% (13/171) of skin blister,4. 7% (8/171) of leg pain, 2. 9% (5/171) of hematuria and 1.8% (3/171) of febrile. By logistic regression analysis, the factor correlated with abdominal pain included diameter of uterine leiomyomas,sonication time and average power (P < 0. 05). The factor correlated with sacroiliac or buttock pain was uterine leiomyomas located in posteriors of uterine wall(P <0. 05); the factors correlated with vaginal bloody discharge were sonication time and type of uterine leiomyomas (submucous > intramural > subserous, P <0. 05); the factors correlated with skin blister was sonication time (P < 0. 05). There were no statistical relationship between multiple factors and leg pain, hematuria, febrile (P > 0. 05). Conclusion The modality of high-power and short-term treatment might reduce complications of HIFU ablation.