The debate on the prevention and treatment of uterine fibroids has progressed with the medical model, highlighting the human prayer for life and quality of life, and therefore the need to dive into the search for the etiology, developmental patterns and methods of prevention and treatment of uterine fibroids. Uterine fibroids, a thousand-year-old disease, has been recorded in medical history for a long time. With the development and wide application of modern medical imaging, more and more uterine fibroids are identified and diagnosed, so it can be called “the first gynecological tumor”. However, because uterine fibroids are rarely malignant, slow-growing, and not life-threatening, the basic and clinical research related to them is not deep and extensive, and the knowledge of contemporary medicine about uterine fibroids is poor, which is a glimpse in the tube. Obviously, uterine fibroids can be likened to a mountain of unknown treasures. For a long time, clinical medicine has oscillated between two extremes in the management of uterine fibroids, either by passively watching and expecting a cure or by removing the uterus, both seemingly as a last resort. With the progress of medical model, highlighting the human prayer for life and quality of life, therefore, it is necessary to dive into the search for the etiology, development pattern and prevention methods of uterine fibroids. 1, pay attention to epidemiological research different ages, different races, different regions and different diagnostic methods or data sources can lead to very different statistics on the prevalence of uterine fibroids. Recent studies published in China with relatively large sample size suggest that the prevalence of uterine fibroids is 11.21%, and most epidemiological data also suggest that the prevalence of uterine fibroids is about 10%. The reason for this is that domestic data are generally derived from population-based census results, and the prevalence of fibroids is highly variable when stratified by age, race, and the presence or absence of fibroid-related symptoms. The prevalence of uterine fibroids in patients with symptoms such as excessive menstruation or abdominal pain was close to zero before the age of 19 or 20 years, while in perimenopausal women over the age of 40 years, the prevalence of fibroids was as high as 32.9% to 45.4%. Kjerulff et al. pathologically analyzed 445 hysterectomized patients with benign disease, 74.5% of whom had combined uterine fibroids, and by race, 89% of whom were black and 59% of whom were white. Obviously, the traditional conclusion that 20% of women over 30 years of age have fibroids according to autopsy statistics is challenged. The etiology of fibroids is bizarre and inconclusive, and therefore, primary prevention has not been possible to date, but relevant epidemiological studies may shed light. Uterine fibroids are recognized as hormone-dependent tumors, and while early epidemiological etiological studies focused on endocrine and reproductive factors, recent studies have expanded to include reproductive tract infections, metabolic, dietary, stress, and environmental factors, which have been suggested to be strongly associated with the development of fibroids. Currently, there is a lack of high-quality epidemiological data both nationally and internationally on the prevalence, incidence, and various factors associated with uterine fibroids in the general population and in various specific populations. Epidemiological studies, including molecular epidemiological studies, are the basic and clinical outposts, and good epidemiological data can benefit the follow-up studies a lot. China has a large population and a wide range of case sources, so it should make a difference in this field, in order to find new strategies for prevention and treatment of uterine fibroids from the root of etiology. 2.Improve the ability to distinguish benign from malignant uterine fibroids Once a uterine fibroid becomes a smooth muscle sarcoma, its “docile” nature is completely changed and it is a serious threat to life. The prognosis for uterine smooth muscle sarcoma is poor, with a low 5-year survival rate (40%-85%) and a high recurrence rate (38%-50%), and adjuvant treatments such as chemotherapy and radiotherapy are not sensitive. Uterine smooth muscle sarcoma mainly originates from smooth muscle cells in the myometrium and is divided into two types: primary and secondary. Primary smooth muscle sarcoma originates from the smooth muscle tissue in the myometrial wall or intermyometrial vascular wall, while secondary smooth muscle sarcoma is a malignant transformation of a pre-existing smooth muscle tumor, and the malignancy usually starts from the center of the nucleus and spreads to the surrounding area. A recent study in the United States (data from a meta-analysis of 133 clinical studies) noted that the probability of finding malignancy during surgery for uterine fibroids was 0.51 per 1,000 based on postoperative pathology. This value is much lower than the 0.13%-2.02% rate of malignant fibroids previously reported in the foreign literature and the 0.4%-0.8% rate reported in China. The findings of pathologists may be useful for gynecologists to avoid more uterine sarcomas, but gynecologists should be fully aware of the limitations of pathologists’ sampling, the subjective nature of identification, and the mixed benign and malignant components of tumor specimens. Clinicians should value clinical information. The initial diagnosis of uterine fibroids is not difficult, but preoperative benign-malignant identification of fibroids and intraoperative cryopathological identification of fibroids remain a difficult problem for the physician. Although some sarcomas are characterized by rapid growth within a short period of time or continue to grow after menopause, most uterine smooth muscle sarcomas are not clinically specific in terms of symptoms compared to benign fibroids, and there are no signs to distinguish the two, nor are there corresponding tumor markers. Currently, ultrasound and magnetic resonance imaging (MRI) are the main adjuvant examinations used in clinical practice. Ultrasound shows that the echogenicity of uterine smooth muscle sarcoma is more disorganized, and there is no obvious demarcation with normal myometrium, and the tumor surface and internal blood flow are rich, and the blood flow resistance (RI) is lower than that of uterine fibroids. MRI has multi-directional imaging function and good soft tissue contrast resolution, which can show the overall structure of the uterus and the relationship between the surrounding tissues well. MRI has been used to diagnose uterine fibroids in the past, but with the development of the economy and the popularity of laparoscopic techniques, this test is becoming more and more functional. For patients with multiple fibroids that require preservation of reproductive function, preoperative evaluation with MRI is a good method to accurately locate and count fibroids and to carefully design uterine incisions and surgical procedures. However, MRI is of limited value in identifying benign and malignant fibroids. Typical MRI of uterine smooth muscle sarcoma shows indistinct demarcation from the uterus, frequent compression of surrounding tissues, and more hemorrhagic necrotic cystic lesions within the tumor with corresponding signal display. However, because fibroids are prone to various degenerations, MRI is difficult to determine accurately. The diagnosis of uterine fibroids still relies on pathology as the gold standard, however, although it is necessary to select frozen pathology during surgery for clinical suspicion of fibroid malignancy, the conclusion may not be credible. Currently, the histological criteria for the diagnosis of uterine smooth muscle sarcoma are based on three parameters: the presence or absence of coagulative tumor cell necrosis, the degree of cytologic atypia, and the nuclear division index. Unfortunately, not all smooth muscle sarcomas present these characteristic changes at the same time, and some may present only one or two or more features. How to identify and analyze these three parameters together becomes crucial for the correct diagnosis of uterine smooth muscle sarcoma. The above criteria are difficult for paraffin pathology, let alone rapid cryopathology, especially in cases with specific types of pathology such as specially differentiated epithelioid and mucinous smooth muscle sarcomas. Nevertheless, in cases of postmenopausal fibroids that continue to grow without cause, it is important to exchange information between clinicians and pathologists, who also need to be aware of clinical information in order to be alert and avoid misdiagnosis. Molecular pathology diagnosis may improve the detection rate of uterine sarcoma. Pérot et al. showed that mutations in the RNA polymerase II transcriptional regulator 12 (MED12) gene have a specific role in the pathogenesis of uterine fibroids and that the presence of MED12 protein may inhibit the occurrence of malignant lesions. It is expected that the development of precision medicine can provide opportunities for this purpose. 3, uterine fibroids minimally non-invasive prevention and treatment and the timing change uterine fibroids are affected by many people, there is no cure yet, invasive surgical treatment is still the main means of treatment. The main treatment is invasive surgery, which is still the main treatment method. The doctor treats the untreated disease, but the cause of uterine fibroids is not yet known, so it is the second best thing to try to detect and treat it early to avoid canker sores. The problem is that the current treatment is more or less traumatic, and when faced with the harm of the progression of fibroids and the harm of medical trauma, it is important to weigh which is more important. The history of human medical development is bound to move from massively invasive, minimally invasive to non-invasive, i.e. medical trauma will gradually weaken and tip the scales towards early intervention of the disease. More and more scholars agree that symptomatic fibroids need to be treated, that is, asymptomatic fibroids can be clinically observed regardless of their size, while symptomatic ones need to be operated regardless of their size, without neglecting the psychological feelings of patients. Obviously, the current treatment of fibroids should be individualized and decided according to the patient’s age, symptoms, size and growth site of fibroids, fertility needs, previous treatment, and the patient’s feelings about the uterus, which is also a woman’s dignity. In recent years, some scholars have suggested that for young, fertile and asymptomatic patients with uterine fibroids, early intervention with the help of current minimally invasive means, instead of waiting for the fibroids to continue to grow and progressively destroy the myometrium and endometrium, early intervention has the advantages of less damage, faster recovery, less impact on fertility and relieving patients’ concerns, such as the current magnetic resonance guided focused ultrasound (HIFU) for For example, the current magnetic resonance-guided focused ultrasound (HIFU) has a good effect on the treatment of fibroids above 2 cm in the anterior wall of the uterus, but such a view requires a large sample of long-term comprehensive evidence, so as to avoid the suspicion of overtreatment, in which the key issue is to take into account the effectiveness, trauma, and health economic value of the treatment, but the general principle should be that if the trauma caused by the treatment measures tends to be absent, the time of intervention should be moved. In patients with fibroids of reproductive potential, the size, location, and number of fibroids should be adequately evaluated, especially those affecting the endometrium, with the help of transvaginal ultrasound, hysteroscopy, and MRI. In general, submucosal fibroids should be operated aggressively to increase the likelihood of pregnancy. Submucosal fibroids ≤5 cm are suitable for hysteroscopic surgery, while submucosal fibroids >5 cm depend on the operator’s experience; interstitial and subplasmic fibroids that do not affect the endometrium are not recommended for surgery. The choice of laparoscopic and open surgical approach depends on the patient’s size, number, location, and intraoperative experience; open uterine fibroid removal is performed with an anterior wall incision to minimize adhesions. Uterine artery embolization is not recommended for patients with fertility requirements to avoid affecting ovarian function and subsequent pregnancy. The concept of minimally invasive surgery is gradually gaining popularity, and there is a wide range of minimally invasive techniques, such as laparoscopic/hysteroscopic surgery for uterine fibroids, negative surgery, HIFU therapy, arterial embolization (UAE), radiofrequency therapy, etc., which are gradually replacing the traditional open hysterectomy and myomectomy, but they cannot replace the traditional surgical approach yet. However, they cannot replace traditional surgical methods yet, and each treatment modality has its own indications and contraindications. Ultrasound focused therapy for uterine fibroids has the advantages of non-invasive, no anesthesia, no incision, outpatient treatment, etc. It is gradually being used in clinical practice, and more and more studies have demonstrated the safety and effectiveness of this technique for uterine fibroids and its low impact on pregnancy. However, any technology has its limitations, and the disadvantages of HIFU treatment include long treatment time, limitations by the size, location and blood supply of treated fibroids, and complications such as skin and nerve damage, which are believed to have greater application in the future as the technology matures. It is worth mentioning that although the technology of laparoscopic surgery for uterine fibroids is becoming more and more mature, and the risk of complications such as damage to blood vessels and intestines is bound to decrease gradually, the problem of tumor dissemination due to laparoscopic uterine fibroid crushing is a serious risk to patients’ lives and should be given great attention. 2014 US FDA issued a serious warning about laparoscopic myomectomy, which was attributed to The probability of incidental uterine sarcoma in uterine fibroid surgery is 1/352, and the probability of uterine smooth muscle sarcoma is 1/498, in which 25% to 64% of cases, the uterine smooth muscle sarcoma becomes stage III or IV from early stage due to myoma crushing; and the 5-year survival rate of patients with uterine smooth muscle sarcoma is 60% for stage I, 22% for stage III, and 15% for stage IV, so the consequences for those patients with incidental malignant tumors are Therefore, for those patients with incidental malignant tumors, the consequences are catastrophic. There is no doubt that laparoscopic technology and the accompanying uterine fibroid crushing technology is a milestone in the history of human medical development, with less trauma and faster recovery thus benefiting the majority of patients, and the minimally non-invasive technology is the direction of medical development, which is unstoppable, but the road of development cannot be smooth. It is an indisputable fact that laparoscopic uterine fibroids crushing can cause medical proliferation and metastasis. In the face of priceless life, it is worthless to continue to argue about its incidence, but it is necessary to be scientific and rational, not for the sake of good but not for the sake of evil, the principle of tumor-free is a rigid rule, which is the fear of life. The principle of no-tumor is a rigid rule and a reverence for life. Obviously, on the one hand, if we give up laparoscopic treatment of uterine fibroids because of choking, it is a retrograde step and not a wise one; on the other hand, if we still don’t pay attention to it and don’t think about repentance and improvement, it is a slaughter of human lives and God forbid. In fact, the problem of metastasis caused by the smashing of uterine fibroids is undoubtedly a problem encountered in the development of minimally invasive technology, and the problems encountered in development should be solved by developmental methods, which is also the direction clinicians need to study. Therefore, contemporary minimally invasive physicians need to calmly grasp the opportunities and meet the challenges in order to contribute to the development of human medicine.