The experience of ulipristal acetate using in patients with uterine leiomyoma
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.
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