Title: Ulipristal in Fibroids
Authors: Dr Manjula S, MD, Dr Ramya Kumaran, Dr Alla Satyanarayana Reddy
DOI: https://dx.doi.org/10.18535/jmscr/v7i9.42
Abstract
Symptomatic uterine fibroids are managed by surgery. The medical management involves Tranexamic acid, OC pills, Progesterone, LNG IUS, GnRH analogues, as a temporary measure pre operatively. Selective Progesterone Receptor Modulators (SPRMs) are new group of drugs for the medical management. Ulipristal acetate is a SPRM, clinically approved drug in the management of fibroids.
The study was conducted at a tertiary care hospital in South India. Fifty women with fibroids and menorrhagia, awaiting definitive surgery or pre-operative to make them fit for surgery or wants medical treatment- are the subjects of the study. At the initiation of the treatment blood loss was quantified by PBAC scale. The number and volume of the fibroids were assessed by ultrasonography. Associated symptoms were recorded. Urlipristal acetate 5 mg daily was given for three months. Blood loss, amenorrhoea, and volume of fibroids was assessed at three months of treatment. Side effects were recorded. They were followed for further three months for resumption of menses.
The mean blood loss was reduced by 88 %. Eighty two percent of women had amenorrhoea. There was 28.2 % of reduction in the volume of the fibroids. There were no troublesome side effects. Two amenorrhic women had hot flushes. 47 resumed menses in 30-40 days and the bleeding was normal or slightly less. There was relief from dysmenorrhoea and pressure symptoms of fibroids
The results of the study were compared with those of other studies. In terms of control of menorrhagia and reduction of fibroid size, 5 mg dose of ulipristalis equally efficacious as 10 mg dose.
Keywords: Symptomatic Fibroids; Menorrhagia; Ulipristal acetate; SPRMs.
References
- Donnez et al. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med 2012;366(5): 409-420
- Donnez et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med 2012; 366(5): 421-436
- Jacques Donnez et al. Ulipristal acetate for the management of large uterine fibroids associated with heavy bleeding: a review. Reproductive Boi Medicine Online 2018; 37(2): 216-223
- Arnedas K et al. Use of Ulipristal acetate for the management of fibroid-related acute abnormal uterine bleeding. J Obstet Gynaecol Can. 2016; 38(1): 80-3
- Kalampokas T et al. Ulipristal acetate for uterine fibroids: a systematic review and meta- analysis. GynecolEndocrinol. 2016; 32(2): 91-6
- Surendra et al. A randomised control trial evaluating role of Ulipristal acetate versus leuprolide acetate in management of fibroid- Redefining role of each. International Journal of Surgery Science 2018; 2(2): 03-07
- Geetha Rani et al. Comparative study of Mifipristone and Ulipristal acetate as Medical management of uterine fibroids in symptomatic patients of reproductive age group. Med Plus International Journal of Gynaecology, volume 9, issue 2, February 2019.