Obstetric gynaecology is a field where diagnostic ultrasound has rapidly gained significance, particularly in birth defect screening and pregnancy monitoring. Therapeutic ultrasound, especially high-intensity focused ultrasound (HIFU), plays a pivotal role in this specialty. While there are several research avenues in this field, the only validated application in our specialty is the treatment of fibroids. HIFU therapy operates through two primary mechanisms: direct thermal effects and mechanical cavitation effects. The thermal effect results from the release of ultrasound wave energy, causing localized heat accumulation through particle friction. Focused high-energy ultrasound is precisely directed at specific points to elevate temperatures locally and induce tissue coagulation. Furthermore, ultrasound can impart a mechanical impact on tissues by harnessing the phenomenon of cavitation. Robust and brief ultrasonic pulses induce the formation of bubbles, generating sufficient force to displace tissues. As these bubbles attain a critical size, they implode, generating shockwaves within tissues and releasing free radicals. In this comprehensive review, we provide insights into the present state and the evolving role of HIFU therapy in obstetric and gynaecological practice.