CLINICAL AND MORPHOLOGICAL RATIONALE FOR THE ULIPRISTAL ACETATE PRE-OPERATION TREATMENT BEFORE ORGANPRESERVING OPERATIONS IN MYOMAS UTERUS PATIENTS WITH THE INTRAUTERINE BLEEDING AND ANAEMIA

Objective: assessment of the feasibility and safety of the use of ulipristal acetate on the basis of the clinical and morphological study.Materials and methods: the study involved 78 women with leiomyoma, abundant menstruation and anemia. Group I – 43 patients who underwent ulipristal acetate therapy for three months and then laparoscopic myomectomy. Group II – 35 patients who were myomectomyed without presurgical preparation. A comparative analysis was made of the clinic-laboratory data, operational parameters, pathomorphological changes in the nodes and endometrium. According to the original clinical laboratory study groups I and II were almost homogeneous.Results: in the case of ulipristal acetate therapy in all group I patients uterine bleeding ceased, the size of the myomatous nodules decreased by an average of 25 per cent according to the ultrasound and the MRI (p < 0.05), the haemoglobin and the ferritin levels reached normal values (p < 0.01). In group I there was a decline in the duration of the operation and blood loss compared to group II. Some leiomyoma reduction mechanisms have been identified. In endometrium of group I patients drug pathomorphosis after therapy was diagnosed. However, the immunohistochemical study made it possible to establish that these changes were benign and reversible.Conclusions: presurgical treatment by ulipristal acetate of reproductive age patients with myomas, uterine bleeding and anaemia is appropriate, safe and pathogenetically justified. The possibility to use repeated courses of the drug, which may eventually postpone or cancel the need for surgical treatment is promising

Hormonal assessment of patients of reproductive age with uterine myoma for surgical treatment

Aim: To assess the efficacy and safety of ulipristal acetate (UA) use in uterine myoma patients before surgical treatment. Material and methods: 78 patients of reproductive age with uterine bleeding and anemia, who underwent laparoscopic myomectomy, were included in the study. Patients were divided into two groups: the first group consisted of 43 women who received 5 mg of ulipristal acetate daily for 3 months before the operation and the second group consisted of 35 patients without ulipristal treatment. A comparative analysis was made between clinical laboratory data groups, pathomorphological changes in myoma and endometrial nodes, and long-term treatment results. Results: As a result of UA therapy uterine bleeding stopped in all patients of the first group, the size of myoma nodes decreased by 25% according to visual diagnostics data, hemoglobin content normalized without iron-containing drugs. Duration of the operation and volume of intraoperative blood loss were less in the first group of patients in comparison with such parameters in the second group. Conclusion: Use of ulipristal acetate for preoperative assessment of patients with uterine myoma of reproductive age suffering from uterine bleeding and anemia is effective and safe

Current trends in the pharmacotherapy of uterine myoma, associated with heavy menstrual bleeding and anemia: a literature review

Aim: to summarize up-to-date world data on current opportunities of drug therapy in treatment of symptomatic myoma accompanied with heavy menstrual bleeding and anemia.Materials and Methods. A search of publications was carried out in the main international databases published in Russian and English: PubMed/MEDLINE, The Cochrane Library, Embase, and eLibrary. The analysis included studies published over the last 10 years examining the clinical efficacy and safety of various groups of pharmacological agents used for treatment of uterine myoma combined with heavy menstrual bleeding in women of reproductive age.Results. Currently, treatment of uterine fibroids consists of the three major approaches: surgical, minimally invasive organpreserving methods, and pharmacotherapy. Until now, surgical intervention remains the main method of treatment, unfortunately being often performed in a foem of hysterectomy. However, today it is important to apply a personalized approach to the management of a female patient with symptomatic uterine myoma, taking into account her wish to preserve reproductive function. Advances in drug therapy greatly contributed to optimizing management of such patients.Conclusion. Treatment of symptomatic uterine fibroids globally tends to lowering the number of radical interventions, as well as develop and improve new therapeutic approaches for. Currently, pharmacotherapy of leiomyoma can substantially improve the quality of patients' life, lower number of radical surgical interventions, optimize surgical treatment, and even fully negate, in some cases, a need for surgery