Various treatment options have been proposed for the management of human symptomatic
uterine fibroids (or
myomas). Despite this, the most popular one is surgery (
myomectomy or
hysterectomy).
Ulipristal acetate (UA) is a selective
progesterone receptor modulator. In women programmed for surgical treatment for
uterine fibroids, oral UA treatment (5 or 10 mg/day) controls symptoms, reduces
tumor size and improves quality of life as compared to placebo and is not inferior to monthly
intramuscular injection of
leuprolide acetate for 3 months. Women treated with up to 4 courses of UA (10 mg/day for 3 months) followed or not by
norethisterone acetate (10 mg/day for 10 days or placebo) reported a high rate of
bleeding control, and improved quality of life,
pain anxiety and depression. Median
fibroid volume after successive courses of UA treatment ranged from -63% to -72% as compared to baseline value. Endometrium showed benign histological changes without
hyperplasia, while adverse events were mild or moderate throughout the several courses of treatment. There is a need for global cost assessment of UA treatment for
uterine fibroids, including those women that do not reach their expected outcome and need other complementary explorations or treatments. Studies are needed in non-Caucasian women, in infertile patients and in cases of
fibroids associated with
adenomyosis. Furthermore, assessment of long-term UA treatment should include endometrial, cardiocirculatory and neurological endpoints.