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.

1. Segars J.H., Parrott E.C., Nagel J.D., Guo XC., Gao X., Birnbaum L.S., Pinn V.W., Dixon D. Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations. Human Reproduction Update. 2014;20(3):309-333. doi: 10.1093/humupd/dmt058.

2. Whinott R.M., Vaught K.C.C., Segars J.H. The effect of uterine fibroids on infertility: a systematic review. Semin Reprod Med. 2017;35(6):523-532. doi: 10.1055/s-0037-1607295.

3. Kozachenko A.V., Revazova Z.V., Adamyan L.V., Demura T.A. Clinical and morphological rationale for the ulipristal acetate pre-operation treatment before organpreserving operations in myomas uterus patients with the intrauterine bleeding and anaemia. Meditsinskiy sovet = Medical Council. 2017;(13):8-14. (In Russ.) doi:10.21518/2079-701X-2017-13-8-14.

4. Revazova Z.V., Adamyan L.V., Kozachenko A.V. Results of combination treatment in reproductiveaged patients with hysteromyoma accompanied by menorrhagias. Akusherstvo i ginekologiya = Obstetrics and Gynecology. 2016;(9):94-100. (In Russ) doi:10.18565/aig.2016.9.94-100.

5. Adamyan L.V., Serov V.N., Sukhikh G.T., Filippov O.S. (ed.). Uterine myoma: diagnostics, treatment and rehabilitation [Mioma matki: diagnostika, lecheniye i reabilitatsiya.]. Clinical recommendations (treatment protocol). 2015. (In Russ.) Available at: https://www.minzdrav29.ru/health/normativnyepravovyedokumenty/klinical_protokols/%D0%9C%D0%B8%D0%BE%D0%BC%D0%B0%20%D0%BC%D0%B0%D1%82%D0%BA%D0%B8.pdf.

6. Ali M., Al-Hendy A. Selective progesterone receptor modulators for fertility preservation in women with symptomatic uterine fibroids. Biol Reprod. 2017;97(3):337-352. doi: 10.1093/biolre/iox094.

7. Bouchard P. Selective progesterone receptor modulators: a class with multiple actions and applications in reproductive endocrinology, and gynecology. Gynecol Endocrinol. 2014;(10):683-684. doi: 10.3109/09513590.2014.950647.

8. Lethaby A., Puscasiu L., Vollenhoven B. Preoperative medical therapy before surgery for uterine fibroids. Cochrane Database Syst Rev. 2017;(11):CD000547. doi: 10.1002/14651858.CD000547.pub2.

9. Luketic L., Shirreff L., Kives S., Liu G., El Sugy R., Leyland N., Solnik M.J., Murji A. Does ulipristal acetate affect surgical experience at laparoscopic myomectomy? J Minim Invasive Gynecol. 2017;(5):797-802. doi: 10.1016/j.jmig.2017.02.025.

10. De Milliano I., Twisk M., Ket J.C., Huirne J.A., Hehenkamp W.J. Pre-treatment with GnRHa or ulipristal acetate prior to laparoscopic and laparotomic myomectomy: a systemic review and meta-analysis. PLoS One. 2017;12(10):e0186158. doi: 10.1371/journal.pone.0186158.

11. Ferrero S., Racca A., Tafi E., Alessandri F, Venturini P.L, Leone Roberti Maggiore U. Ulipristal acetate before high complexity hysteroscopic myomectomy: a retrospective comparative study. J Minim Invasive Gynecol. 2016;23(3):390-395. doi: 10.1016/j.jmig.2015.12.002.

12. Murji F., Wais M., Lee D., Pham A, Tai M, Liu G. A multicenter study evaluating the effect of ulipristal acetate during myomectomy. J Minim Invasive Gynecol. 2018;25(3):514-521. doi: 10.1016/j.jmig.2017.10.016.

13. De Milliano I., Van Hattum D., Ket J.C.F., Huirne J.A.F., Hehenkamp W.J.K. Endometrial changes during ulipristal acetate use: a systematic review. Eur J Obstet Gynecol Reprod Biol. 2017;(214):56-64. doi: 10.1016/j.ejogrb.2017.04.042.

14. Mallick R., Oxley S., Odejinmi F. The use of ulipristal acetate (Esmya) prior to laparoscopic myomectomy: help or hindrance? Gynecol Minim Invasive Ther. 2019;8(2):62-66. doi: 10.4103/GMIT.GMIT_79_18

15. Willame A., Marci R., Petignat P., Dubuisson J. Myoma migration: an unexpected «effect» with Ulipristal acetate treatment. Eur Rev Med Pharmacol Sci, 2016;20(8):1439-1444. Available at: https://www.ncbi.nlm.nih.gov/pubmed/?term=Myoma+migration%3A+an+unexpected+%22effect%22+with+Ulipristal+acetate+treatment

16. Murji A., Whitaker L., Chow T.L., Sobel M.L. Selective progesterone receptor modulators (SPRMs) for uterine fibroids. Cochrane Database Syst Rev. 2017;(4):CD010770. doi: 10.1002/14651858.CD010770.pub2.

17. Whitaker L.H., Murray A.A., Matthews R., Shaw G., Williams A.R., Saunders P.T., Critchley H.O. Selective progesterone receptor modulator (SPRM) ulipristal acetate (UPA) and its effects on the human endometrium. Hum Reprod. 2017;32(3):531-543. doi: 10.1093/humrep/dew359.