OP24.09: Ulipristal acetate (UPA) therapy increased ultrasound features of adenomyosis: a good treatment given in an erroneous diagnosis of uterine fibroids

Abstract

To describe sonographic findings in patients with adenomyosis erroneously treated with ulipristal acetate (UPA). This an observational ultrasound (US) study on premenopausal patients who were treated with UPA for menorrhagia and uterine fibroids. Patients undergoing UPA treatment (5mg/24h of oral UPA for 3 months) usually had a pre treatment scan to diagnose and evaluate uterine fibroid's volume and endometrial status. The US exam is usually repeated at the end of the 3months treatment in order to assess effects on UPA on fibroids and endometrium. Ideally both these ultrasound scans should be performed in the same unit however not always this occurs. On 42 patients treated with UPA and observed in our ultrasound unit, 18 were scheduled only at the end of the treatment. Of these 6 patients did not show typical fibroids at US but an enlarged uterus with typical US features of adenomyosis. All patients receiving UPA showed after treatment amenorrhea and improvement of symptoms related to their previous anemia. 36 out of 42 patients with US detected fibroids showed also an improvement of their pain due to their uterine pathology whereas in the 6 patients with adenomyosis pelvic pain was increased and 2 of this patients stopped the UPA treatment within the first 2 months. In 21% (10/42) patients we observed typical endometrial thickening induced by UPA therapy of these 3 had adenomyosis. The adenomyosis features and especially intramyometrial cystic areas seem to be enlarged compared to pre-treatment scan not performed in our unit. Our observations on patients with adenomyosis who underwent UPA treatment for an erroneously diagnosis of uterine fibroid showed a worsened of the US adenomyotic features and of their pelvic pain, with an improvement of the bleeding. After these observations we should be aware to prescribe UPA therapy in patients with adenomyosis and a correct US diagnose of fibroids in mandatory to start the UPA treatment.