The experience of ulipristal acetate using in patients with uterine leiomyoma




uterine myoma, therapy, ulipristal acetate


In the study of clinical experience of the use of ulipristal acetate (UPA) – a selective modulator of progesterone receptors – in women with symptomatic uterine leiomyoma, 65 women with a clinically significant tumor were treated. The drug was given to patients both as a drug monotherapy, and as a stage of complex treatment before surgery.

The analysis of the effectiveness of therapy in terms of primary clinical results, the features of changes in the ultrasound pattern, as well as intraoperative features and the possibilities of restoring the reproductive function was held. Thus, with monotherapy was reduced the severity of clinical manifestations of abnormal metrorrhagia (in 63 of 65 women), was decreased the volume of nodes by 35.5 ± 9.8% on average, with a very slight decrease in their linear axial dimensions measured in perpendicular ultrasound sections (in an average of 10.13 ± 0.48%), as well as was tagged a reduction in 3D-PD indices of vascularization of the leiomyoma nodes and the degree of vascularization of nodes in ultrasound scanning in the color Doppler mapping mode. A persistent relapse-free effect of volume reduction and vascularization of the myoma node was noted during the first year of follow-up. Combined treatment in several cases had the effect of a «slippage» of the myomatous node with the transformation of the 2–3th type of growth into the 0–1 type, a significant decrease in intraoperative blood loss was noted in comparison with patients who had not received preoperative preparation of the UPA (120 ± 26 vs. 190 ± 33 ml, p <0.05), as well as facilitation of the surgical stage of node exudation provided that the pseudocapsule is correctly identified. The restoration of reproductive function in 6 patients with the possibility of urgent vaginal birth was noted.

In the opinion of the authors of the article, to assess the effectiveness of preoperative preparation, it is inappropriate to do a control ultrasound study before the end of the 12-week course of the UPA. In addition, sonologists performing ultrasound monitoring of treatment should take into account the features of node measurement and specific changes in the endometrium associated with selective modulators of progesterone receptors. In general, the use of UPA opens up new opportunities and prospects for the management of patients with uterine leiomyoma in both monotherapy and multi-stage combined treatment.

Author Biographies

Р. А. Сафонов, Kharkiv Regional Perinatal Center

PhD, head of Operative Gynecology with Minimally Invasive Technologies Department

И. Н. Сафонова, Kharkiv Medical Academy of Postgraduate Education; Kharkіv Regional Perinatal Center

PhD, associate professor at the Radiation Diagnostics Department;

ultrasound diagnost doctor


  1. Zimmermann, A., Bernuit, D., Gerlinger, C., et al. “Prevalence, symptoms and management of uterine fibroids: an international internetbased survey of 21,746 women.” BMC Womens Health 12 (2012): 6.
  2. Munro, M.G., Critchley, H.O., Broder, M.S., Fraser, I.S. “The FIGO Classification System (“PALMCOEIN”) for causes of abnormal uterine bleeding in nongravid women of the reproductive years, including guidelines for clinical investigation.” Int J Gynaecol Obstet 113 (2011): 3–13.
  3. Wainsteker, K., Emanuel, M.H., de Kruif, J.H. “Transcervical hysteroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension.” Obstet Gynecol 82 (1993): 736–40.
  4. Carr, B.R., Marshburn, P.B., Weatherall, P.T., et al. “An evaluation of the effect of gonadotropinreleasing hormone analogs and medroxyprogesterone acetate on uterine leiomyomata volume by magnetic resonance imaging: a prospective, randomized, double blind, placebocontrolled, crossover trial.” J Clin Endocrinol Metab 76 (1993): 1217–23.
  5. Friedman, A.J., Daly, M., JuneauNorcross, M., et al. “A prospective, randomized trial of gonadotropinreleasing hormone agonist plus estrogenprogestin or progestin “addback” regimens for women with leiomyomata uteri.” J Clin Endocrinol Metab 76 (1993): 1439–45.
  6. Friedman, A.J., Hoffman, D.I., Comite, F., et al. “Treatment of leiomyomata uteri with leuprolide acetate depot: a doubleblind, placebocontrolled, multicenter study. The Leuprolide Study Group.” Obstet Gynecol 77 (1991): 720–5.
  7. Lefebvre, G.G., Vilos, G., Asch, M. “Uterine fibroid embolization (UFE). SOGC Clinical Practice Guidelines, No. 150, October 2004.” J Obstet Gynaecol Can 26 (2004): 913–28.
  8. ChabbertBuffet, N., PintiauxKairis, A., Bouchard, P.; VA2914 Study Group. “Effects of the progesterone receptor modulator VA2914 in a continuous low dose on the hypothalamicpituitaryovarian axis and endometrium in normal women: a prospective, randomized, placebocontrolled trial.” J Clin Endocrinol Metab 92 (2007): 3582–9.
  9. Donnez, J., Tatarchuk, T.F., Bouchard, P., et al. “Ulipristal acetate versus placebo for fibroid treatment before surgery.” N Engl J Med 366 (2012): 409–20.
  10. Donnez, J., Tomaszewski, J., Vazquez, F., et al. “Ulipristal acetate versus leuprolide acetate for uterine fibroids.” N Engl J Med 366 (2012): 421–32.
  11. Donnez, J., Vazquez, F., Tomaszewski, J., et al. PEARL III and PEARL III Extension Study Group. “Long-term treatment of uterine fibroids with ulipristal acetate.” Fertil Steril 101 (2014): 1565–73.
  12. Luyckx, M., Squifflet, J.L., Jadoul, P., et al. “First series of 18 pregnancies after ulipristal acetate treatment for uterine fibroids.” Fertil Steril 102.5 (2014): 1404–9.
  13. De Milliano, I., Van Hattum, D., Ket, J.C.F., et al. “Endometrial changes during ulipristal acetate use: A systematic review.” Eur J Obstet Gynecol Reprod Biol 214 (2017): 56–64.
  14. Vilos, G.A., Allaire, C., laberge, P.Y., et al. “The management of uterine leiomyomas.” J Obstet Gynaecol Can 37.2 (2015):157–78.
  15. Ros, C., Martinez-Serrano, M., Angeles, M., et al. “Ultrasound assessment of fibroids treated with ulipristal acetate.” UOG Vol 46, Issue Suppl S1 (2015): 223.
  16. Capmas, P., Levaillant, J., Fernandez, H. “Sonographic findings after ulipristal acetate treatment in women with uterine myoma.” Vol 48, Issue S1 (2016): 240–1.



How to Cite

Сафонов, Р. А., & Сафонова, И. Н. (2017). The experience of ulipristal acetate using in patients with uterine leiomyoma. REPRODUCTIVE ENDOCRINOLOGY, (36), 76–81.



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