DOI: https://doi.org/10.18370/2309-4117.2018.43.77-81

Progesterone “against” progesterone. New links in the pathogenesis and future strategies in treatment of uterine fibroids

А. Н. Григоренко

Abstract


Uterine myoma is a benign monoclonal solid tumor of the pelvis emanating from the smooth muscle tissue of the myometrium. Previously, it was considered that only hyperestrogens are the cause of the appearance and growth of fibromatosis. The high prevalence of uterine fibroids in the population forces the scientific world to explore the most subtle pathogenetic mechanisms in order to find an individual, personalized approach to its treatment.

The last decade has been quite rich with new data on the pathogenesis of uterine fibroids, and yet, none of the theories of the initiation of the pathological process not been fully studied. At the same time, experts understand the situation and have a certain resource for pathogenetically influence on the growth of fibroids. “Turning off” the action of steroid hormones, and especially progesterone, is possible to create the conditions for the natural involution of fibroids. Therefore, the appearance of ulipristal acetate has changed the views on treatment and preoperative preparation of women with uterine myomas.

Unreasonable use of medicine threatens patients with uterine myoma with adverse effects. Therefore, in modern conditions, a careful control is carried out to the choice of treatment method and patients to whom one or another method is indicated. Modern treatment of uterine myoma is a personalized approach and a combination of various methods (surgical and non-surgical).

To date, it has been shown that ulipristal acetate allows not only delaying surgery, but in some cases avoiding it altogether. After treatment with ulipristal acetate,

the therapeutic effect is more pronounced and lasts longer compared to other pharmacological regimens proposed earlier. This opens up great prospects for practical gynecology, including its outpatient level. With proper use, monitoring, and proper selection of patients, ulipristal acetate is an innovative strategy for organ-preserving uterine fibroids when surgical treatment is not indicated.


Keywords


uterine fibroids; progesterone; proliferation; ulipristal acetate; Esmya

References


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Zaitseva, M., Vollenhoven, B.J., Rogers, P.A. “In vitro culture significantly alters gene expression profiles and reduces differences between myometrial and fibroid smooth muscle cells.” Mol Hum Reprod 12 (2006): 187–207.


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21.     Rossouw, J.E., Anderson, G.L., Prentice, R.L., et al. “Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial.” JAMA 288 (2002): 321–33.

22.     Szamatowicz, M., Kotarski, J. “Selective progesterone receptor modulator (ulipristal acetate – a new option in the pharmacological treatment of uterine fibroids in women.” Ginekol Pol 84.3 (2013): 219–22.

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24.     Wise, L.A., Laughlin-Tommaso, S.K. “Epidemiology of uterine fibroids – from menarche to menopause.” Clin Obstet Gynecol 59.1 (2016): 2–24.

25.     Zaitseva, M., Vollenhoven, B.J., Rogers, P.A. “In vitro culture significantly alters gene expression profiles and reduces differences between myometrial and fibroid smooth muscle cells.” Mol Hum Reprod 12 (2006): 187–207.





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