P14.05: Macroscopic endometrial findings in patients with myomas treated with ulipristal acetate: ultrasonographic and hysteroscopic correlations with histologic analysis

Abstract

To study the correlation between ultrasonographic, hysteroscopic and histologic findings of endometrial changes associated with a standard 3-month ulipristal acetate treatment. A prospective observational study of women undergoing treatment with ulipristal acetate was conducted in a University teaching and research hospital, tertiary referral centre. Seventy-one women with one or more symptomatic myomas were monitored after a 12-week cycle of ulipristal administration (5 mg/day). Patients underwent pre- and post-treatment transvaginal ultrasound and hysteroscopy; guided endometrial samples were collected after treatment to reveal the presence of PAEC features (Progesterone-receptor modulator associated endometrial changes). Endometrial ultrasound and hysteroscopic findings were recorded (endometrial thickness, vascularisation, appearance). Ultrasound findings were normal in most patients but in 6 (8.45%) showed patterns suggestive of endometrial changes (only one showed PAEC after histological analysis); The mean endometrial thickness did not significantly change during treatment except in 3 patients (4.2%) with a thickness ≥16 mm. Hysteroscopically, the endometrium was altered in 5 (7.04%) patients after ulipristal treatment; of these, 4 patients presented histological findings of PAEC. The mean volume of the dominant fibroid was 243 cc (95% CI, 158.71-327.28). Reductions, albeit not statistically significant, were observed in the mean dominant fibroid volume and uterine volume. Our results seem to indicate that hysteroscopic findings are better correlated with the pathological analysis than transvaginal ultrasound for detecting PAEC patterns related to ulipristal acetate treatment.