Background: Uterine fibroids are the most common benign gynecologic tumors, with a lifetime incidence of approximately 70%. They are associated with multiple symptoms, including heavy uterine bleeding and pelvic pain. Currently used treatments include contraceptive steroids, Gonadotropin-releasing hormone agonist (GnRHa), progesterone modulators, uterine artery embolization (UAE), magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS), and radiofrequency ablation (RFA). Objective: To evaluate the effect of atorvastatin on decreasing fibroid related symptoms and fibroid size, endometrial thickness and cholesterol level in perimenopausal women. Patients and methods: Prospective randomized controlled trial that was conducted over a period of 12 months during 2019 and 2021 on 105 patients with symptomatic uterine fibroid in perimenopausal age, admitted to emergency unit and gynecology outpatient clinic at Mansoura University Hospital and after obtaining acceptance from institutional research board faculty of medicine then patients were prospectively recruited and randomized by computer program. Results: All groups at presentation demonstrated insignificant differences concerning demographic characteristics, gravidity and symptoms of uterine fibroid. Uterine fibroid demonstrated significant reduction in size as well as significant changes following the atorvastatin treatment after 6 months in a dose dependent manner, while endometrial thickness demonstrated insignificant differences as measured by transvaginal ultrasound (TVS). Cholesterol level demonstrated highly statistically significant decrease following atorvastatin treatment in a dose dependent manner. Conclusion: The current study demonstrated that atorvastatin has promising effects in cases with uterine fibroids as it was associated with a reduction of fibroid size with reduction of fibroid related symptom (menorrhagia, dysmenorrhea).