Preoperative treatment of uterine leiomyomas with ulipristal acetate

  • Andrej Vogler Department of Human Reproduction, Division of Gynaecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  • Mišo Rajić Zdravstveni dom za študente Univerze V Ljubljani
Keywords: leiomyoma, medical treatment, surgery, ulipristal acetate

Abstract

Background: Uterine leiomyomas are the most common benign uterine tumours in women. They are symptomatic in 20 to 50 % of cases. Symptoms associated with leiomyomas include heavy, prolonged menstrual bleeding leading to anaemia, dysmenorrhoea, pelvic pressure and pain, impaired function of adjacent organs, such as bladder and bowel, and reproduction dysfunction. Options for medical therapy are currently limited to preoperative reduction of symptoms related to uterine bleeding and fibroid size. Recently, selective progesterone receptor modulators (SPRM) have been introduced and approved in preoperative treatment of leiomyomas. The aim of our study was to assess the efficacy of preoperative treatment with SPRM ulipristal acetate (UPA) on leiomyoma shrinkage and haemoglobin (Hb) concentration improvement.

Methods: Fifty patients with symptomatic leiomyomas were assigned for preoperative treatment with 5 mg of UPA daily for 12 weeks. Before and a week after the UPA treatment was completed, leiomyoma volume was measured, and Hb concentrations and the amount of uterine bleeding were assessed. The outcomes were changes from baseline in leiomyoma volume and the proportion of patients with controlled bleeding after the treatment.

Results: After the completion of UPA treatment there was a mean volume reduction of the largest myoma by 33.3 %, whereas the mean volume reduction of up to 3 largest myomas was 32.3 %. Volume reduction was in both cases statistically significant. During the treatment course 41 (82.0 %) women were amenorrhoeic and the other 9 (18.0 %) had a significant reduction in uterine bleeding. The reduction in bleeding was accompanied by improvement in Hb levels in all patients.

Conclusion: Preoperative treatment with UPA for 12 weeks effectively reduces leiomyoma volume and facilitates or even makes laparoscopic surgery feasible. It is also beneficial for correcting anaemia, which is of outmost importance for postoperative recovery.

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Published
2019-01-20
How to Cite
1.
Vogler A, Rajić M. Preoperative treatment of uterine leiomyomas with ulipristal acetate. TEST ZdravVestn [Internet]. 20Jan.2019 [cited 29Mar.2024];87(11-12):509–518. Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/2633