Role of selective progesterone receptor modulators in the treatment of symptomatic uterine fibroids

Background: Uterine leiomyomas are benign tumours of smooth muscle cells and fibrous tissue that develop within the wall of the uterus. Objective of this study was to compare efficacy and safety of Mifepristone and Ulipristal acetate in the treatment of symptomatic uterine fibroids.Methods: The present randomized comparative prospective study was conducted among 120 non-pregnant and non-lactating females of age 25-50 years with symptomatic fibroids reported in the department of obstetrics and gynecology, Chhatrapati Shivaji Subharti Hospital, Meerut, Uttar Pradesh for a duration of 2 years from September 2017 to July 2019.The selected subjects were divided into two treatment arms i.e. Group 1: ulipristal acetate: 5 mg OD for 3 months and Group 2: mifepristone: 25 mg OD for 3 months. Detailed history of the patient, general physical examination and systemic examination was done followed by per abdomen examination, per speculum and per vaginal examination. A blood examination, USG (pelvis), Pap smear and endometrial biopsy was done. Subjects visited the hospital at visit 1, visit 2, visit 3, visit 4, visit 5 and visit 6 for 6 months.Results: In both the groups, maximum subjects were in the age group of 36-40 years, followed by 41-50 years. When mean PBAC score at first, second, third, fourth and fifth visit was compared statistically among ulipristal acetate and mifepristone group, it was found to be statistically significant. Uterine pain was reduced more in mifepristone group as compared to ulipristal acetate group at all the different intervals. Size was reduced more in mifepristone group as compared to ulipristal acetate group at all the different intervals.Conclusions: Authors conclude from this study that mifepristone should be preferred over ulipristal acetate for treatment of symptomatic fibroids.

To Compare the Efficacy of Ulipristal acetate and Mifepristone in Management of Uterine Fibroids in Symptomatic Patients of Reproductive Age Group

Introduction: Uterine myomas incidence is variable asmost of the patients are asymptomatic but most commonclinical feature which makes women seek their treatment aremenorrhagia and iron deficiency anaemia leading to chronicfatigue. Study aimed to compare the efficacy of UPA andmifepristone in medical management of uterine fibroids insymptomatic patients of reproductive age group.Material and methods: A prospective randomizedobservational study was carried out, in women with single ormultiple uterine leiomyoma. Exclusion criteria: severe anemia,using any hormonal therapy, with suspected carcinomas orwith adnexal masses. 100 patients were randomly allocatedto two subgroups; group A receiving 5 mg UPA and groupB receiving 25 mg Mifepristone daily, for 13 weeks. PBACwas used to assess menstrual blood loss and Likert scorefor other symptoms. Baseline variables: uterine size andvolume, Myoma size and volume, number, hemoglobin, liverfunction tests were noted and reassessed at 1, 3 and 6 months.Endometrial sampling was done initially and at the end tostudy.Results: Mean fibroid volume reduction was 35.23% in groupA and 33.45% after 13 weeks’ treatment in group B. Meanreduction in menorrhagia: 84% in group A and 52.5% in groupB. 91% cases experienced amenorrhoea in group A and 72%in group B.Conclusion: UPA 5mg was better at achieving significantreduction in menorrhagia and achieving amenorrhoeic state ascompared to Mifepristone.

Criterios Médicos de elegibilidad para el uso de anticonceptivos de la OMS / Medical eligibility criteria for the use of WHO contraceptives

Introducción: Los "Criterios Médicos de Elegibilidad para el Uso de Anticonceptivos" de la Organización Mundial de la Salud (OMS) son una guía para la correcta elección y uso de los métodos anticonceptivos en variadas condiciones de salud. En este documento revisaremos las principales modificaciones en su quinta y última edición publicada en inglés el año 2015. Desarrollo: Las modificaciones de la quinta edición son fundamentalmente la adición de nuevos métodos y la modificación de la categoría de recomendación para algunas condiciones de salud. Se agregan el acetato de medroxiprogesterona de depósito vía subcutánea, el anillo vaginal de progesterona, el implante anticonceptivo subcutáneo sinoimplant(II)® y el método anticonceptivo de emergencia acetato de ulipristal. Se modifican las recomendaciones para las mujeres en lactancia, permitiendo el uso de algunos métodos de progestágeno solo desde el posparto inmediato, salvo el acetato de medroxiprogesterona de depósito por entregar una dosis elevada del esteroide y el dispositivo intrauterino (DIU) con levonorgestrel, el cual sigue las normas de los DIU con cobre. También hay modificación en las recomendaciones en cuanto al uso de anticonceptivos combinados en el puerperio, con más restricciones para mujeres sin lactancia. Por último, sobre el uso de terapia antiretroviral, cambian algunas categorías y se amplía el listado de fármacos detallados. Conclusión: Es necesario que los profesionales de salud conozcan estas modificaciones para poder entregar una atención de calidad a las usuarias de anticoncepción.

Introduction: The "Medical Eligibility Criteria for Contraceptive Use" published by the World Health Organization (WHO) is a guide for the correct choice and use of the contraceptive methods in many different health conditions. In this document we will review the main changes made in the fifth and last edition of this guide published in English in 2015. Development: The modifications of this last edition are the addition of new contraceptive methods and the modification of the category of the recommendation for some health conditions. It adds the medroxiprogesterone acetate subcutaneous injection, the progesterone vaginal ring, the subcutaneous contraceptive implant sinoimplant(II)® and ulipristal acetate as emergency contraception. There are modifications of the recommendations for breastfeeding women, allowing the use of some progestin only methods since the immediate postpartum, with the exception of medroxiprogesterone acetate because it delivers a high dose of the steroid and the levonorgestrel intrauterine device that follows the same recommendations as the copper intrauterine device. There are also modifications in the recommendations for the use of combined contraceptives in the first 42 days postpartum, with more restrictions for non-breastfeeding women. Finally, on the use of antiretroviral therapy drugs, there were changes of some categories and a detailed categorization for each drug. Conclusion: It is necessary for health care providers to know these changes in order to deliver a quality care to contraception users.

Ulipristal Acetate: The Latest in Emergency Contraception.

Unintended pregnancy is a global reproductive health problem. Emergency contraception (EC) provides women with a safe means of preventing unwanted pregnancies following unprotected intercourse. Current gold standard emergency contraceptive is levonorgestrel (LNG) given within 72 hours of unprotected intercourse. Ulipristal acetate is a selective progesterone receptor modulator (SPRM) recently approved by US FDA for emergency contraception. It can be used upto five days (120 hours) after an unprotected intercourse and a single dose of 30 mg is effective.