Medical Management of Symptomatic Uterine Fibroids: A New Option?

　　Ulipristal acetate was effective and did not cause hypoestrogenism.

　　Uterine fibroids (the most common indication for hysterectomy) occur in one third of reproductive-age women. In two manufacturer-sponsored trials, European researchers assessed the efficacy of oral ulipristal acetate (UA) — a selective progesterone-receptor modulator — for treating women in whom surgery for symptomatic fibroids was planned. (UA is currently marketed as ella in the U.S. for emergency contraception [JW Womens Health Jan 12 2012].) The first study was a placebo-controlled trial of two different doses of UA; the second was a noninferiority trial designed to compare UA with monthly injections of leuprolide, a gonadotropin-releasing hormone agonist. In both trials, study drugs were administered for 13 weeks, at which time surgery could be pursued.

　　Both doses of UA were highly effective at reducing menstrual blood loss; in both studies, three quarters of women who received this agent became amenorrheic within 10 days. UA suppressed menstrual blood loss more rapidly than leuprolide. Although leuprolide alleviated symptoms associated with fibroid volume more effectively than UA, follow-up at 6 months in women who did not undergo surgery showed that fibroid shrinkage was more persistent with UA. Menstruation returned a mean of 32 days and 43 days after stopping UA and leuprolide, respectively. Unlike leuprolide, UA had little effect on serum levels of estrogen and bone markers and did not cause hot flashes. Although nonphysiologic endometrial changes typically associated with selective progesterone-receptor modulators occurred in almost two thirds of UA recipients during treatment, these changes resolved 6 months after UA discontinuation.

Related Link://www.nurftech.com/detail/162097.html