Efficacy of selective progesterone receptor modulator in patients with uterine fibroids
Maria Yarmolinskaya (RU), Anna Tsypurdeeva (RU), Marina Kusevitskaya (RU), Maka Kakhiani (RU), Gulrukhsor Tolibova (RU), Tatyana Tral (RU)
[Yarmolinskaya] Ott‘s Scientific Research Institute of Obstetrics, Gynecology and Reproduction, [Tsypurdeeva] Ott‘s Scientific Research Institute of Obstetrics, Gynecology and Reproduction, [Kusevitskaya] Hospital 31, [Kakhiani] Ott‘s Scientific Research Institute of Obstetrics, Gynecology and Reproduction, [Tolibova] Ott‘s Scientific Research Institute of Obstetrics, Gynecology and Reproduction, [Tral ] Ott‘s Scientific Research Institute of Obstetrics, Gynecology and Reproduction
Context. The choice of effective schemes of treatment and prevention of recurrence of uterine fibroids is an urgent problem, especially in women of reproductive age, who are interested in realization of reproductive function. Objective: to evaluate effectiveness of various courses of therapy with ulipristal acetate (UA) at a dose of 5 mg in patients with uterine fibroids. Methods and Patient(s): 119 patients with symptomatic uterine fibroids received UA at a dose of 5 mg. Among them, 92 patients received this medication as a preoperative preparation therapy for 3 months, 17 patients were treated with UA using intermittent prolonged courses (3-4 courses, each lasting for 3 months with breaks) after surgery as recurrence prevention. The age of patients varied from 29 to 46 years, the size of nodes varied from 3 to 12cm. 45 patients had large fibroids, the others were detected multiple fibroids (2 to 6 nodes). Menometrorrhagia was observed in 87% of patients, anaemia in 73% of patients. For those patients who underwent laparoscopic myomectomy after treatment with UA, histological and immunohistochemical study of endometrium was performed. Result(s):After treatment, mean volume reduction of fibroids was 51.6±17.4%. Reliable significant increase in hemoglobin levels was shown. We revealed specific changes in endometrium structure, which are characterized by cystic expansion of glands, proliferative epithelium and increase in the area of expression of estrogen and progesterone receptors, which should be regarded as therapeutic pathomorphosis ("PAEC effect"). In 78% of patients who received prolonged intermittent courses of UA, there were no cases of fibroid recurrence during 1.5-year observation period. Conclusions. UA is effective for preoperative preparation as well as for long-term course of anti recurrence treatment of patients with uterine fibroids.