{"doi":"10.1016/j.xfss.2021.02.002","title":"Fast forward: fibroid management in 2042","abstract":"It is January 5, 2042. I did not have surgeries this week, only office visits, teaching, and research. The first patient scheduled in the clinic today was a 42-year-old lady with a body mass index of 34 kg/m2 and a history of hypertension. She initially presented for heavy periods and pelvic pain. Imaging revealed several small fibroids, and her laboratory results showed elevated cholesterol and triglycerides. Her fibroid biomarkers suggested that her metabolic disorders were contributing to the development of her fibroids. I discussed the findings with her, recommended lifestyle changes, and started her on simvastatin. I also started her on an angiotensin-converting enzyme (ACE) inhibitor for her elevated blood pressure. My second patient was a 29-year-old lady presenting for a uterine fibroid screening consultation. Her demographic, family history, and clinical findings alerted her primary care providers to a high risk of fibroids and referred her to me. The routine fibroid panel had been completed before her visit. Her laboratory results showed a low vitamin D level and elevated biomarkers predicting uterine fibroids. I entered her body mass index, blood laboratory results, and family history of uterine fibroids in the uterine fibroid risk calculator. Her risk of developing uterine fibroids over the next 5 years was elevated. I counseled her, recommended lifestyle modifications, including a healthier diet and more exercise to lose weight, and started her on vitamin D. As I reflect back on our management of uterine fibroids, we have come a long way. In the past, effective medications to treat this condition were limited, and we performed surgery on many of our patients because we did not have other effective options. We also had limited understanding of the pathogenesis of uterine fibroids, and we were more interested in treating than preventing fibroids. Shifting our focus to prevent the development of uterine fibroids by lifestyle changes and medications was groundbreaking and improved the lives of millions of women in our country and worldwide. Fibroid markers were proposed a while ago before being further developed and incorporated into practice (1Levy G. Hill M.J. Plowden T.C. Catherino W.H. Armstrong A.Y. Biomarkers in uterine leiomyoma.Fertil Steril. 2013; 99: 1146-1152Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar). The benefits of vitamin D in uterine fibroid management were known for some time before vitamin D treatment was widely implemented (2Ali M. Shahin S.M. Sabri N.A. Al-Hendy A. Yang Q. Hypovitaminosis D exacerbates the DNA damage load in human uterine fibroids, which is ameliorated by vitamin D3 treatment.Acta Pharmacol Sin. 2019; 40: 957-970Crossref PubMed Scopus (15) Google Scholar, 3Ali M. Prince L. Al-Hendy A. Vitamin D and uterine fibroids: preclinical evidence is in; time for an overdue clinical study!.Fertil Steril. 2020; 113: 89-90Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar). Similarly, the association of fibroids with cardiometabolic risk factors was known for years before it was implemented in fibroid prevention programs (4AlAshqar A. Patzkowsky K. Afrin S. Wild R. Taylor H.S. Borahay M.A. Cardiometabolic risk factors and benign gynecologic disorders.Obstet Gynecol Surv. 2019; 74: 661-673Crossref PubMed Scopus (8) Google Scholar). The association of uterine fibroids with obesity, hypertension, and metabolic syndrome offered the potential for clinical intervention by lifestyle changes and medications. The possible beneficial effects of simvastatin, an antihyperlipidemic drug, on uterine fibroids also were demonstrated (5Malik M. Britten J. Borahay M. Segars J. Catherino W.H. Simvastatin, at clinically relevant concentrations, affects human uterine leiomyoma growth and extracellular matrix production.Fertil Steril. 2018; 110: 1398-1407.e1Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 6Afrin S. Islam M.S. Patzkowsky K. Malik M. Catherino ","journal":"F&S Science","year":2021,"id":208150,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9411,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":405226,"name":"Mostafa A. Borahay","orcid":"0000-0002-0554-132X","position":1,"is_corresponding":false},{"id":397356,"name":"Malak El Sabeh","orcid":"0000-0002-7556-2900","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-18T23:51:53.662668Z","pmid":"34355207","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}