Uterine myomas are most widely-spread tumors that affect women in perimenopause, cause bleeding, pain, and declining quality of life. Although there are surgical methods aimed to preserve the uterus, the use of pharmaceutical drugs is associated with lower expenses and complications. Ulipristal acetate (UPA), a selective progesterone receptor modulator, is indicated for patients with uterine myoma to control bleeding and to reduce the volume of myoma in 80% of cases. At treatment with UPA, the volume of myoma reduces because of the combination of the inhibition of cell proliferation, cell death stimulation, and fibrosis resorption. In case of recurrence of symptoms, intermittent courses of 3-month UPA daily therapy sufficiently increases the treatment efficacy, sometimes leading to a complete regress of uterine myoma. Although the UPA therapy dose is well tolerated, patients with anomalies or disorders of liver must be excluded in screening procedures according to the recommendations of the European Committee for Medical Products — Pharmacovigilance Risk Assessment Committee (PRAC). There are proposed new algorithms of treating patients with symptomatic uterine myomas in merimenopause depending on their localization, patient preferences, and clinical laboratory results at the monitoring of liver enzymes and bilirubin according the PRAC recommendations in order to minimize risks of possible toxic effect on liver.