Background: Uterine fibroids are tumor of the smooth muscles and the connective tissue of the uterus. They are considered to be the most common benign tumor of the pelvis. Conservative surgery remains the main approach for management of uterine myomas. Myomectomy is considered to be an important option for women who desire future childbearing or simply want to preserve their uterus. Objective: The aim of the study was to compare between the effect of pericervical uterine artery tourniquet (surgical) and perioperative vaginal misoprostol (medical) regarding their efficacy to decrease blood loss during trans- abdominal myomectomy. Methods: Prospective randomized controlled clinical trial. The study was approved by the Ethical Research Committee. The study was conducted in Obstetrics and Gynecology Department, Zagazig University Hospital. The study included 36 women with symptomatic myomas randomized into Group A included 18 patients who underwent uterine artery tourniquet and Group B included 18 patients who received single dose of 400 μg vaginal misoprostol one-hour before surgery. Results: The present study showed that there was statistically significant difference between both groups regarding intra-operative blood loss, operative time, the need for blood transfusion and amount of fluid within the post-operative drain. Conclusion: Pericervical mechanical tourniquet in comparison with pre-operative vaginal misoprostol is more effective method in; reducing both intra-operative and post-operative blood loss, and shortening of operative time during transa-bdominal myomectomy.