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

Authors

DOI:

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

Keywords:

uterine fibroids, progesterone, proliferation, ulipristal acetate, Esmya

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.

Author Biography

А. Н. Григоренко, Vinnitsya National Pirogov Memorial Medical Univercity

MD, assistant of Obstetrics and Gynecology Department No.2

References

  1. Adamyan, L.V., ed. Uterine fibroids: diagnosis, treatment and rehabilitation. Clinical guidelines for the management of patients. Moscow. Academician V.I. Kulakov Scientific Center for Obstetrics, Gynecology and Perinatology (2015): 100 p.
  2. Radzinsky, V.E., Totchiev, G.F. Uterine fibroids: course on organ preservation. Newsletter. Moscow. Editorial board of StatusPraesens magazine (2014): 24 p.
  3. Carr, B.R., Marshburn, P.B., Weatherall, P.T., et al. “An evaluation of the effect of gonadotropin-releasing hormone analogs and medroxyprogesterone acetate on uterine leiomyomata volume by magnetic resonance imaging: a prospective, randomized, double blind, placebo-controlled, crossover trial.” J Clin Endocrinol Metab 76 (1993): 1217–23.
  4. Donnez, J. “With the advent of selective progesterone receptor modulators, what is the place of myoma surgery in current practice?” Fertil Steril 102.3 (2014): 640–8.
  5. Donnez, J. “Liver injury and ulipristal acetate: an overstated tragedy?” Fertil Steril 110.4 (2018): 593–4. DOI: 10.1016/j.fertnstert.2018.06.044
  6. Eisinger, S.H., Meldrum, S., Fiscella, K., et al. “Low-dose mifepristone for uterine leiomyomata.” Obstet Gynecol 101 (2003): 243–50.
  7. Fiscella, K., Eisinger, S.H., Meldrum, S., et al. “Effect of mifepristone for symptomatic leiomyomata on quality of life and uterine size: a randomized controlled trial.” Obstet Gynecol 108 (2006): 1381–7.
  8. Friedman, A.J., Daly, M., Juneau-Norcross, M., et al. “A prospective, randomized trial of gonadotropin-releasing hormone agonist plus estrogen-progestin or progestin “add-back” regimens for women with leiomyomata uteri.” J Clin Endocrinol Metab 76 (1993): 1439–45.
  9. Harrison-Woolrych, M.L., Charnock-Jones, D.S., Smith, S.K. “Quantification of messenger ribonucleic acid for epidermal growth factor in human myometrium and leiomyomata using reverse transcriptase polymerase chain reaction.” J Clin Endocrinol Metab 78 (1994): 1179–84.
  10. Lamminen, S., Rantala, I., Helin, H. “Proliferative activity of human uterine leiomyoma cells as measured by automatic image analysis.” Gynecol Obstet Invest 34 (1992): 111–4.
  11. Loginova, O.N., Sonova, M.M., Arslanyan, K.N. “Progesterone and uterine fibroids. A review of the literature.” The Journal of scientific articles “Health and Education Millennium” 20.1 (2018). DOI: 10.26787/nydha-2226-7425-2017-20-1
  12. Moravek, M.B., Yin, P., Ono, M., et al. “Ovarian steroids, stem cells and uterine leiomyoma: therapeutic implications.” Hum Reprod Update 21.1 (2015): 1–12. DOI: 10.1093/humupd/dmu048
  13. Morikawa, A., Ohara, N., Xu, Q., et al. “Selective progesterone receptor modulator asoprisnil down-regulates collagen synthesis in cultured human uterine leiomyoma cells through up-regulating extracellular matrix metalloproteinase inducer.” Hum Reprod 23 (2008): 944–51.
  14. Mulac-Jericevic, B., Mullinax, R.A., DeMayo, F.J., et al. “Subgroup of reproductive functions of progesterone mediated by progesterone receptor-B isoform.” Science 289 (2000): 1751–4.
  15. Murphy, A.A., Kettel, L.M., Morales, A.J., et al. “Regression of uterine leiomyomata in response to the antiprogesterone RU 486.” J Clin Endocrinol Metab 76 (1993): 513–7.
  16. Murphy, A.A., Morales, A.J., Kettel, L.M., Yen, S.S. “Regression of uterine leiomyomata to the antiprogesterone RU486: dose-response effect.” Fertil Steril 64 (1995): 187–90.
  17. Nurmenniemi, S., Sinikumpu, T., Alahuhta, I., et al. “A novel organotypic model mimics the tumor microenvironment.” Am J Pathol 175 (2009): 1281–91.
  18. Palomba, S., Sena, T., Morelli, M., et al. “Effect of different doses of progestin on uterine leiomyomas in postmenopausal women.” Eur J Obstet Gynecol Reprod Biol 102 (2002): 199–201.
  19. Pérez-López, F.R., Ornat, L., Ceausu, I., et al. “EMAS position statement: management of uterine fibroids.” Maturitas 79.1 (2014): 106–16.
  20. Rogers, R., Norian, J., Malik, M., et al. “Mechanical homeostasis is altered in uterine leiomyoma.” Am J Obstet Gynecol 198 (2008): 474.e1–474.e11.
  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.
  23. Tiltman, A.J. “The effect of progestins on the mitotic activity of uterine fibromyomas.” Int J Gynecol Pathol 4 (1985): 89–96.
  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.

Published

2018-12-03

How to Cite

Григоренко, А. Н. (2018). Progesterone “against” progesterone. New links in the pathogenesis and future strategies in treatment of uterine fibroids. REPRODUCTIVE ENDOCRINOLOGY, (43), 77–81. https://doi.org/10.18370/2309-4117.2018.43.77-81

Issue

Section

Tumors and pretumoral pathology