CLINICAL AND MORPHOLOGICAL RATIONALE FOR THE ULIPRISTAL ACETATE PRE-OPERATION TREATMENT BEFORE ORGANPRESERVING OPERATIONS IN MYOMAS UTERUS PATIENTS WITH THE INTRAUTERINE BLEEDING AND ANAEMIA

Abstract

Objective: assessment of the feasibility and safety of the use of ulipristal acetate on the basis of the clinical and morphological study. Materials and methods : the study involved 78 women with leiomyoma, abundant menstruation and anemia. Group I – 43 patients who underwent ulipristal acetate therapy for three months and then laparoscopic myomectomy. Group II – 35 patients who were myomectomyed without presurgical preparation. A comparative analysis was made of the clinic-laboratory data, operational parameters, pathomorphological changes in the nodes and endometrium. According to the original clinical laboratory study groups I and II were almost homogeneous. Results : in the case of ulipristal acetate therapy in all group I patients uterine bleeding ceased, the size of the myomatous nodules decreased by an average of 25 per cent according to the ultrasound and the MRI (p < 0.05), the haemoglobin and the ferritin levels reached normal values (p < 0.01). In group I there was a decline in the duration of the operation and blood loss compared to group II. Some leiomyoma reduction mechanisms have been identified. In endometrium of group I patients drug pathomorphosis after therapy was diagnosed. However, the immunohistochemical study made it possible to establish that these changes were benign and reversible. Conclusions : presurgical treatment by ulipristal acetate of reproductive age patients with myomas, uterine bleeding and anaemia is appropriate, safe and pathogenetically justified. The possibility to use repeated courses of the drug, which may eventually postpone or cancel the need for surgical treatment is promising.