A systematic review and meta-analysis compared transradial approach (TRA) and transfemoral approach (TFA) in uterine artery embolization (UAE) for the treatment of symptomatic uterine fibroids. Six studies with 639 patients were included, of which 324 (50.7%) in the TRA group with a mean age of 43.48 ± 6.23 years and 315 (49.3%) in the TFA group with a mean age of 42.97 ± 6.33 years. TRA showed significantly lower radiation exposure (MD = −207.54 mGy, 95% CI [−262.42, −152.67], p < 0.00001), shorter procedure time (MD = −7.38 min, 95% CI [−10.09, −4.67], p < 0.00001) and higher same-day discharge rate (RR = 9.50, 95% CI [3.76, 24.03], p < 0.00001). There were fewer access site complications (RR = 0.55, 95% CI [0.31, 0.97], p = 0.04), especially hematomas (RR = 0.32, 95% CI [0.14, 0.74], p = 0.007). There was no significant difference in the time of fluoroscopy. The failure rate of TRA was low (0.3%). TRA is a safe and effective alternative to TFA.