• New aspects in the treatment of uterine leiomyoma associated with endometriosis

New aspects in the treatment of uterine leiomyoma associated with endometriosis

HEALTH OF WOMAN. 2017.7(123):32–35; doi 10.15574/HW.2017.123.32

Kaminskiy V. V., Prokopovych E. V.
National Medical Academy of Postgraduate Education PL. Shupika, Kiev
Kiev City Center of Reproductive and Perinatal Medicine, Kiev

Despite the high level of development of modern surgery and pharmacology, none of the surgical techniques (hysterectomy / myometectomy or embolization of the uterine arteries) or drug therapy is not a guarantee of the absence of a future recurrence of uterine fibroids and endometriosis. However, there are methods of effective pharmacotherapy for their manifestations. In particular, selective progesterone receptor modulators (SMPR) demonstrate high efficacy in respect of the symptoms of myoma and the size of the nodes, which allows them to be considered as a complete alternative to the surgical treatment of uterine fibroids.
The objective: evaluation of the effectiveness of the use of SMPR in the treatment of combined gynecological diseases.
Patients and methods. The study included materials for the observation of 40 women 20–52 years old with uterine myoma against the background of combined gynecological pathology (endometriosis, infertility), which carried out the enucleation of myomatous nodes by laparotomy, laparoscopic or transcervical access.
Patients were divided into two groups. In the main group (n=20), women received SMPR – ulipristal acetate (UPA) 5 mg daily for 3 months. The UIA's bioavailability is 70%. The optimal therapeutic single dose for the analyzed pathology is 5 mg. After 3 months, the first assessment of the effectiveness of the drug with combined gynecological pathology was conducted, then 14 women were exposed to surgical treatment, and 6 of 20 patients continued conservative treatment for another 1–4 months. After the operation to prevent the recurrence of uterine fibroids and endometriosis, 8 patients continued treatment of UPA for 4 months. In the comparison group (n=20), women underwent surgical treatment at similar rates, but the SMPR was not assigned to surgery.
Results. Of the studies indicate that the use of such a selective modulator of progesterone receptors, like vandalite acetate, in the treatment of uterine myomas in combination with endometriosis is safe and well tolerated, leads to rapid persistent coping of uterine bleeding, a significant decrease in the size of nodes and foci of endometriosis, and the achieved The therapeutic effect is maintained even after the abolition of therapy.
Conclusion. Thus, the use of the drug ulipristal acetate in the treatment of uterine fibroate on the background of combined gynecologic pathology is highly effective and promising as an independent and integrated treatment method of this category of patients.
Key words: uterine myoma, endometriosis, selective modulators of progesterone receptors, viperpatel acetate, combined oral contraceptives.


1. Tatarchuk TF, Cossey NV. 2012. Modern principles of treatment of uterine leiomyoma. Health of Ukraine. Thematic Issue :10–13.

2. Uterine Myoma, Myomectomy and Minimally Invasive Treatments. 2015. DOI 10.1007/978-3-319-10305-1.

3. Kaminsky VV, P.V.O., Medvedev MV. 2012. Modern principles of organ-preserving treatment of women with leiomyoma of the uterus: methodical recommendations approved by the Ministry of Health of Ukraine. Dnipropetrovsk:32.

4. Nosenko EN, Skidanova EA. 2013. Progesterone and uterine leiomyoma. Mediko-social problems of the family 18;3:105–110.

5. Cook H, Ezzati M, Segars JH, McCarthy K. 2010. The impact of uterine leiomyomas on reproductive outcomes. Minerva Ginecologica 62(3):225–236.

6. Shannon K. Laughlin, Jane C. Schroeder, Donna Day Baird. 2010. New Directions in the Epidemiology of Uterine Fibroids. Seminars in Reproductive Medicine 03: 204-217. https://doi.org/10.1055/s-0030-1251477.

7. Hauptmann S, Kohler G. 2014. Etiology, Pathogenesis, and Malignant Potential of Uterine Leiomyoma – A Review. Curr Obstet Gynecol Rep. 3:186–190. https://doi.org/10.1007/s13669-014-0091-x

8. Stovall Dale W. 2011. Alternatives to hysterectomy: focus on global endometrial ablation, uterine fibroid embolization, and magnetic resonance-guided focused ultrasound. Menopause 4(18):443–450. https://doi.org/10.1097/gme.0b013e318207fe15; PMid:21701430

9. Radosa MP, Owsianowski Z, Mothes A. 2014. Long-term risk of fibroid recurrence after laparoscopic myomectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology 180:35–39. https://doi.org/10.1016/j.ejogrb.2014.05.029; PMid:25016181

10. Metwally M, Farquhar CM, Li TC. 2011. Is another meta-analysis on the effects of intramural fibroids on reproductive outcomes needed?  Reprod Biomed Online. 23:2–14. https://doi.org/10.1016/j.rbmo.2010.08.006; PMid:21549642

11. Segars JH, Parrott EC, Nagel JD, Guo XC, Gao X, Birnbaum LS et al. 2014. Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations. Hum Reprod Update. 20:309–33. https://doi.org/10.1093/humupd/dmt058; PMid:24401287 PMCid:PMC3999378

12. Dickson E, Skinner BD. 2013. Hysteroscopic Myomectomy: Patient Selection, Preoperative Workup and Surgical Tips and Tricks. Journal of Minimally Invasive Gynecology 20(6) (Suppl):S99. https://doi.org/10.1016/j.jmig.2013.08.320

13. Dariushnia S, Nikolic B, Stokes L, Spie J. 2014. Quality Improvement Guidelines for Uterine Artery Embolization for Symptomatic Leiomyomata. J Vasc Interv Radiol. 25:1737–1747. https://doi.org/10.1016/j.jvir.2014.07.020; https://doi.org/10.1016/j.jvir.2014.08.029; PMid:25442136

14. Munro MG, Critchley HO, Broder MS, Fraser IS. 2011. FIGO classification system (PA LM-COE IN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. FIGO Working Group on Menstrual Disorders. Int J Gynaecol Obstet. 113:1–2. https://doi.org/10.1016/j.ijgo.2011.01.001; PMid:21316671

15. Donnez J, Tomaszewski J, Vazquez F, Bouchard R, Lemieszczuk B, Baro F et al. 2012. REARL-II Study Group. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med. 366:421–32. https://doi.org/10.1056/NEJMoa1103180; PMid:22296076

16. Donnez J, Donnez O, Dolmans M. 2014. With the advent of selective progesterone receptor modulators, what is the place of myoma surgery in current practice? Fertility and Sterility 102(3):640-648. https://doi.org/10.1016/j.fertnstert.2014.06.041; PMid:25106762

17. Julie Kim J, Sefton E. 2012. The role of progesterone signaling in the pathogenesis of uterine leiomyoma. Molecular and Cellular Endocrinology 358(2):223–231. https://doi.org/10.1016/j.mce.2011.05.044; PMid:21672608 PMCid:PMC3184215

18. Bouchard P, Chabbert-Buffet N, Fauser B. 2011. Selective progesterone receptor modulators in reproductive medicine: pharmacology, clinical efficacy and safety. Fertility and Sterility 96;5:1175–1189. https://doi.org/10.1016/j.fertnstert.2011.08.021; PMid:21944187

19. Rabe T, Ahrendt HJ, Albring C, Bitzer J, Bouchard R, Cirkel U, Egarter C, Kunig K, Harlfinger W, Matzko M et al. 2012. Ulipristal Acetate for Symptomatic Uterine Fibroids and Myoma – Related Hypermenorrhea Joint Statement by the German Society for Gynecological Endocrinology and Reproductive Medicine (DGGEF) and the German Professional Association of Gynecologists (BVF). J Reproduktions med Endokrinol. 9(2):106–26.

20. Donnez J, Vazquez F, Tomaszewski J, Nouri K, Bouchard R, Fauser BC et al. 2014. For the REARL-III and REARL-III Extension Study Group. Longterm treatment of uterine fibroids with ulipristal acetate. Fertil Steril. 101:1565-73. e18.