Objective This study was aimed to explore related factors affecting the effect of high intensity focused ultrasound (HIFU) treatment for uterine fibroids, and construct a nomogram model. Methods We retrospectively analyzed the clinical data of 717 patients with uterine fibroids who received HIFU treatment in our hospital between January 2017 and October 2019. The patients were randomly divided into the model group (478 cases) and the validation group (239 cases). The volume reduction of uterine fibroids and reduction of menstrual at 3 months after operation were recorded, and influencing factors in the model group were analyzed. A nomogram model was constructed and verified internally and externally. Results In this study, the volume of uterine fibroids was (90.24±25.68)cm3 before treatment, and (38.45±7.45)cm3 after 3 months of treatment, with an effective uterine fibroids reduction rate of 60.04% (287/478). The effective rate of menstrual reduction was 62.97% (301/478). Multivariate Logistic analysis showed that fibroids volume≥50cm3, fibroids T2WI etc./high signal, T1 obviously enhanced, target skin distance≥5cm were independent risk factors for ineffective volume reduction and ineffective menstrual reduction (P＜0.05). The ineffective uterine fibroids volume reduction model and the ineffective menstrual reduction model constructed using R software were verified internally by Bootstrap self sampling method. In the model group, the C-index of the 2 models was 0.722 and 0.733, and areas under the ROC curves were 0.830 and 0.852 respectively. In the validation group, the C-index of the 2 models was 0.710 and 0.701, and the area under the curve was 0.796 and 0.802, respectively. The Hosmer-Lemeshow goodness of fit test was evaluated, and P values of the volume reduction model in the module and verification group were both higher than 0.05. Conclusion Size, blood supply and target skin distance of uterine fibroids are related to focal reduction and reduction of menstrual after HIFU treatment. The nomogram model can be used to evaluate the treatment effect, thus providing reference for the choice of treatment method.