Uterine
myoma is the most common benign uterine
tumor in women of reproductive age and occurs in 20%-25% of the worldwide population. No currently approved medical treatment is able to completely eliminate
fibroids. Surgery, particularly
hysterectomy, predominates as the treatment strategy of choice, even though it is associated with risks and complications and causes
infertility. Until recently,
gonadotropin-releasing hormone agonists were the only available drugs for the preoperative treatment of
fibroids. However,
ulipristal acetate (UPA), an oral selective
progesterone receptor modulator, was recently licensed in Europe for the same indication. Recent studies have demonstrated the efficacy and safety of UPA in the medical management of
fibroids before surgery, with a better tolerability profile than
leuprolide acetate. Analyzing the literature, we identified new management strategies involving UPA and surgery, considering advantages of both medical and surgical
therapy. The advent of UPA will undoubtedly modify the surgical approach to
fibroids, but the heterogeneity of these possible indications now requires various original clinical studies to identify the optimal indications for UPA in patients with symptomatic
fibroid(s).