Pharmacological approach for the treatment of myoma: early and long-term outcomes.
Zarina Revazova (RU)
[Revazova] Federal State Institution
Introduction: An important role in the development of uterine leiomyomas plays progesterone, estrogene and there receptors, disturbance of cell proliferation activity, apoptosis, angiogenesis, growth factors. Also these processes plays an important role for the development of menorrhagia. Menorrhagia is the most severe symptom of uterine leiomyomas. Heavy bleeding can result in anemia, decreased quality of life. A new opportunity for management of symptomatic fibroids is using ulipristal acetate (SPRM). Objective: To study the efficacy of UA use before LS myomectomy in patients with symptomatic fibroids. Patients: 75 women of reproductive age with symptomatic fibroids (>3 cm, <11 cm). All women wished to retain uteri. Intervention: 40 patients underwent LM after 3 month UA treatment (group I) and 35 patients-LM only (group II). Measurements: Fibroids were diagnosed by ultrasound. PBAC was used to assess menstrual bleeding. Anemia was assessed by the Hb levels. Efficacy of UA was evaluated by: stopping bleeding, decreasing in fibroid volume, increase of Hb, complaints. We evaluated operative and postoperative parameters: operative time, blood loss, Hb levels, hyperthermia, hospital stay. Results: All women in grI reported an improvement in there condition. Excessive bleeding stopped after 4-7 days from start of treat in all patients. Mean PBAC was significantly decreased, mean of Hb-increased. US revealed reliable decrease in fibroid size. The operative time and blood loss in grI was lower then in gr II. Early and long-term postoperative stage was more conductive in grI. Conclusion: Preoperative treatment by UA gives the possibility to do reconstructive surgery (laparoscopic myomectomy) for women of reproductive age with uterine fibroids, menorrhagia and anemia. LM after pretreatment allows surgeons to preserve the uterus with minimal blood loss.