(February 2012 - Insidermedicine)

Treatment with ulipristal acetate can reduce fibroid size and diminish uterine bleeding among women with symptomatic fibroids, according to research published in the February 2 issue of the New England Journal of Medicine.

Here are some recommendations for the use of uterine artery embolization (UAE) to treat fibroids, from the American College of Radiology:

•    Prior to UAE, all prospective patients should undergo a full gynecologic workup.

•    Cross-sectional imaging, preferably ultrasound (US) or magnetic resonance imaging (MRI), should be done to confirm the diagnosis of uterine leiomyomas and exclude other pelvic pathology.

•    Viable pregnancy and active infection are two absolute contraindications for the procedure and must be excluded.

Researchers out of the Cliniques Universitaires Saint-Luc Catholic University of Louvain randomized 242 women with symptomatic fibroids, excessive uterine bleeding, and a hemoglobin level of 10.2 g/dL to received treatment for up to 13 weeks with ulipristal acetate 5 or 10 mg daily or a placebo. All women also received iron supplements. At the end of 13 weeks, patients were eligible to undergo surgery.

By the end of the 13 week treatment period, 91% of women taking the 5 mg dose of ulipristal and 92% of those on the 10 mg dose had their uterine bleeding under control, compared with only 19% of those on placebo. Rates of amenorrhea were 73% with the low dose, 82% with the high dose, and 6% with placebo. When it did occur in women on active therapy, amenorrhea usually developed within 10 days. Total fibroid volume decreased by a median of 21% among the women on low dose ulipristal and 12% for the women on the high dose. In contrast, total fibroid volume actually increased by a median of 3% among women on placebo. Treatment with ulirpristal was associated with benign histologic endometrial changes that resolved within six months of discontinuing therapy. Uterine hemorrhage occurred in one woman taking 10 mg of ulirpristal.

Today’s research suggests that treatment with ulipristal can provide relief for women with symptomatic fibroids, at least until surgery is performed. The risks and benefits of long-term ulipristal therapy require further study.