Update of Conservative Systemic Treatment of Uterine Fibroids

Zalewski, Magdalena; Neulen, Joseph

doi:10.1007/s13669-014-0089-4

Cited by 2 publications

(2 citation statements)

References 31 publications

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“…Since the levonorgestrel intrauterine system (5yr-IUD) became the only United States Food and Drug Administration (FDA) approved medication for HMB treatment in 2009, the 5yr-IUD may no longer be the most effective choice for HMB control [3]. The 5yr-IUD achieves amenorrhea in 70% of users at 3 months, and in 8.8% to 63% of users at 12 months [4][5][6]. At 12 months 79% to 96% of 5yr-IUD users are adherent [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Ulipristal Acetate Effectively Medically Manages Symptomatic Leiomyomatous Uteri

OB¹

2017

IJRFSH

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Background: Symptomatic leiomyomatous uteri affect about 30% of women. Associated anemia, dysmenorrhea, dyspareunia, heavy menstrual bleeding, and mass effects cause quality of life decrements. The 5-year levonorgestrel intrauterine device (5yr-IUD) has been a mainstay of medical management for symptomatic leiomyomata. If approved, Ulipristal acetate (UPA), which entered the European and Canadian markets in 2012 and 2013, could change medical management of symptomatic leiomyomata in the United States. Methods: PubMed search for the term "ulipristal acetate treatment fibroids" yielded five included articles. Hand search provided nine additional articles. Results: The 5yr-IUD achieves maximal amenorrhea in 70% of users at 3 months. Dysmenorrhea improves in 84% of 5yr-IUD users. A Phase III trial with 451 participants compared UPA 5 and 10 mg over four 12-week treatment cycles. At the study end, menstruation was controlled in up to 77.5% of participants, with 70% or more participants in each group achieving amenorrhea. Combined median leiomyoma volume reduction for the three largest leiomyomata reached 67.4%. Median health related QOL scores decreased from 56.9 and 55.2 respectively to 20.7 and 15.5 respectively after the fourth treatment cycle. Conclusion: UPA offers onset amenorrhea within 6 days irrespective of dose, whereas the 5yr-IUD may take 3-months to achieve amenorrhea. UPA decreases leiomyomata volume up to 65% within 1-year, but, the 5yr-IUD does not reduce leiomyomata volume. The 5yr-IUD provides simultaneous contraception, whereas UPA requires separate contraception. As there are no significant benefits to higher dose treatment, UPA 5 mg should have a place in gynecologic clinical practice.

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Section: Introductionmentioning

confidence: 99%

“…At 12 months 79% to 96% of 5yr-IUD users are adherent [4,5]. Dysmenorrhea, im-OPEN ACCESS http://scidoc.org/IJRFSH.php proves in 84% of 5yr-IUD users [6]. Despite increased expulsion from distorted uterine cavities, 5yr-IUD reinsertion is frequently requested [3].…”

Section: Introductionmentioning

confidence: 99%