Surgical Treatment Of Uterine Fibroids Research Articles

Black Women's Psychosocial Experiences with Seeking Surgical Treatment for Uterine Fibroids: Implications for Clinical Practice.

Black women are more likely to undergo surgery for uterine fibroids compared with non-Black women. However, few studies have characterized the psychosocial experiences of Black women seeking fibroid treatment. We aimed to identify factors that shape Black women's fibroid management decisions; explore how discrimination based on race, class, and gender feature in treatment-seeking experiences, and compare experiences across age and socioeconomic status. We conducted semistructured interviews with 37 Black women undergoing surgery for fibroid management. We used a thematic analysis to code transcripts and identify themes. Participants were predominately single, college educated, and insured. Respondents reported that patient-doctor interactions, support from social networks, fertility consequences, and fear of fibroid malignancy influenced their fibroid management decisions. Knowledge and perceptions of fibroids were also influenced by community norms and differed by socioeconomic status; women of higher socioeconomic status had greater fibroid awareness than women of lower socioeconomic status. Discrimination was discussed in the context of historical inequity against Black women, with one participant questioning whether Black women were valued less in clinical settings compared with non-Black women. Although several women discussed positive experiences seeking fibroids care, others expressed medical mistrust or said that alternative management options were not offered by clinicians. Fibroid management decisions were influenced not only by interactions with clinicians and social networks, and concerns about fertility and fibroid malignancy, but also by broader social and historical conditions. These findings suggest that clinicians should deliver intersectional gynecologic care that centers the voices of Black women seeking fibroid treatment.

Predictors of genitourinary syndrome in women of elderly reproductive age after hysterectomy

The article presents an analytical assessment of risk factors for distant postoperative urogenital disorders in women of older reproductive age after radical surgical treatment for uterine fibroids. The aim of the study was to optimize the diagnostic algorithm of genitourinary syndrome in women of older reproductive age after hysterectomy for uterine fibroids. Materials and methods – 80 women aged 40 to 50 years were examined: 40 patients after vaginal and laparoscopically assisted vaginal hysterectomy, 40 patients with abdominal hysterectomy, control – 30 relatively healthy women with asymptomatic fibroids. The examination was performed at the stage of preoperative observation and for 3 years after surgery. Research methods: data on the assessment of pelvic floor and urogenital dysfunction using a standardized POP-Q system, physical examination, the ICS classification was used to assess the severity of urinary incontinence; quality of life assessment using the MOS SF-36 questionnaire; standard methods of variation statistics. Research results and their discussion. The most important risk factors for genitourinary syndrome have been identified. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth trauma, high birth parity, ovarian surgery, the use of gonadotropin-releasing hormone agonists), chronic diseases accompanied by increased intramuscularly; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. Conclusions. In the case of surgical treatment of uterine fibroids, it is advisable to take into account not only the presence of vaginal prolapse and initial dysuric manifestations, but also their predictors in the preoperative stage of the examination, as this may affect the choice of method and access in the case of surgical treatment of uterine fibroids. rehabilitation program and will obtain the expected effect of surgical recovery.

Urogenital disorders in women of reproductive age after radical surgeries about uterine myoma – optimization of diagnostic algorithm

The article presents an assessment and analysis of the most important medical and social risk factors for long-term postoperative urogenital disorders in women of reproductive age after radical surgical treatment for uterine fibroids. Radical operations for uterine fibroids cause an increase in the proportion of urogenital disorders, the clinical manifestations of which have a negative impact on the physical, psycho-emotional form and social significance of women in society. A survey of 80 women aged 40 to 50 years, the main group included 40 patients who underwent vaginal hysterectomy, the comparison group consisted of 40 patients with hysterectomy performed by abdominal access. Data on the assessment of pelvic floor condition and urogenital dysfunction using a standardized POP-Q system, both at the stage of preoperative observation and for 3 and 5 years after surgery. Сonducted surveys, filling diaries of pain, urination, physical examination and bimanual examination, determination of the pH of the vaginal contents, colposcopy, evaluated the index of the vaginal condition, the state of the microbiota of the mucous membranes, a comprehensive urodynamic examination, cystometry, ultrasound examination of the pelvic organs and assessment of ovarian structure.The most important risk factors are identified, which would allow to form groups of patients that require individualized approaches in the choice of surgical techniques and rehabilitation program. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth injuries, high birth parity); ovarian surgery, the use of gonadotropin-releasing hormone agonists. chronic diseases of the respiratory system and gastrointestinal tract, accompanied by increased intra-abdominal pressure; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. When choosing a method and access in case of surgical treatment for uterine fibroids, it is advisable to take into account the presence of pelvic prolapse and initial dysuric manifestations in women, the functional state of the sphincter apparatus and urethral hypermobility, obstetric and gynecological pathology and previous surgery on the organs of the uterus. the patient, her awareness of possible complications, the surgeon’s experience and his choice of surgical techniques.

Surgical treatment of uterine fibroids

What method should be used to operate uterine fibroids and what criterion is currently desirable for solving this important practical issue - these are the thoughts that arise involuntarily when reading any new work on this subject and, despite the many significant improvements described in almost every issue of special periodicals, all these questions usually do not receive a definite answer and there is a vast field for all sorts of doubts when trying to resolve them.

Use of a microsurgical vascular clip system (Yasargil clip) in laparoscopic fibroid enucleation

This video demonstrates the use of a microsurgical temporary vascular clip system to facilitate laparoscopic enucleation of uterine fibroids. Throughout the course of the last three decades, the laparoscopic route has been established as the approach of choice in the surgical treatment of uterine fibroids. Laparoscopic fibroid enucleation is characterized by a low morbidity rate and a high patient satisfaction level. Especially when treating a large fibroid or multiple fibroids, the well-vascularized myometrium can constitute a technical challenge in endoscopic fibroid enucleation. Diffuse bleeding may lead to significant intraoperative hemorrhage. The extensive use of bipolar or monopolar diathermy, in order to achieve hemostasis, might lead to post-operative uterine wall necrosis with a potential risk of uterine rupture during subsequent pregnancies. To address this clinical challenge, we developed a technique with temporary interruption of the uterine blood supply by applying a microsurgical vascular clip (Yasargil vascular clip system, Aesculap, Tuttlingen, Germany) to the uterine artery and the utero-ovarian vessel arcade to minimize bleeding during endoscopic fibroid enucleation.

Modern non-drug technologies of rehabilitation for patients after surgical treatment of uterine myoma

The review article presents data on scientific studies carried out in recent decades on the use of modern non-drug technologies in the rehabilitation of patients after surgical treatment of uterine fibroids.

Миомэктомия: рациональное ведение периоперационного периода и отдаленные результаты лечения

Objective – to study the influence of various surgical approaches on the outcomes of myomectomy and to determine the optimal strategy of postoperative management of patients of childbearing age with uterine fibroids. Patients and methods. A retrospective study included 145 patients who had uterine fibroids with a total increase of 480–560 cm3, with the intramural component not less than 55% of the total volume. Patients of group 1 (n = 62) underwent classical laparoscopic myomectomy. Patients of group 2 (n = 48) had surgery supplemented by temporary reduction of arterial perfusion by temporary clipping of the uterine or internal iliac arteries. Robot-assisted myomectomy was performed in 34 patients of group 3. The comparison group comprised 54 women with uterine fibroids of the same sizes who did not undergo operative treatment, and the control group consisted of 36 healthy women. Results. After myomectomy, the progesterone/oestradiol receptor ratio in the endometrium increased from 1.8 to 4.6 and from 1.6 to 2.7 in patients who suffered from primary or secondary infertility before surgery. After surgery, the expression of НОХА-10 became higher in the epithelium and pinopodes of patients of both groups. But the positive response of the stromal cells was obtained only in women who had pregnancies before surgery. The expression of the proto-oncogene bcl-2 after myomectomy decreased in patients of all groups in both the stroma and epithelium, but it was more pronounced in women with primary infertility. Changes in the endometrium occur irrespective of the type of operative intervention. Taking into account the fact that temporary cessation of arterial perfusion in the uterus does not worsen endometrial receptivity but allows a 5-fold reduction of intraoperative blood loss, this technique might be regarded as one of the most effective for prevention of intra- and postoperative complications. The incidence of pregnancy following myomectomy was 84.7% among women who planned conception, whereas among women with myoma it was only 18.9%. The number of pregnancies after assisted reproductive technologies amounted to 19.4% of the total number of patients. Conclusion. Surgical treatment of uterine fibroids makes it possible to improve a reproductive prognosis and achieve a pregnancy in 85% of cases, which, among other factors, is due to improvement of endometrial receptivity. Key words: pregnancy, contraception, uterine fibroid, myomectomy, reproductive outcomes, endometrial receptivity

Temporary uterine artery occlusion with a Nelaton catheter reduces bleeding during laparoscopic myomectomy for cervical fibroids

Laparoscopic myomectomy (LM) is currently widely used as surgical treatment for uterine fibroids; however, it may be technically challenging in some patients with cervical fibroids in whom laparotomy needs to be performed. Reportedly, preoperative uterine artery embolization and intraoperative cutting and ligation of the uterine artery reduce intraoperative bleeding during myomectomies. Notably, maintaining maximal uterine blood flow is necessary in patients who desire fertility preservation; unfortunately, currently, no such method is available.

Экстракорпоральное оплодотворение и перенос эмбрионов у пациенток после различных методов оперативного лечения миомы матки

Objective. To assess the efficacy of in vitro fertilization (IVF) and embryo transfer in patients who had gone surgical treatment for uterine fibroids using different methods. Patients and methods. This study included 133 patients who were divided into 4 groups depending on the type of treatment for uterine fibroids: no treatment (Group 1), laparotomic or laparoscopic myomectomy (Group 2), hysteroscopic resection of uterine fibroids (Group 3), and uterine artery embolization (UAE) (Group 4). Results. The total number of IVF cycles per patient was 1.8 ± 0.4 after laparoscopic myomectomy, 2.0 ± 0.4 after laparotomic myomectomy, 0.4 ± 0.2 after hysteroscopic resection, 2.1 ± 0.3 after no treatment, and 3.9 ± 0.5 after UAE. Mean number of punctures was 1.3 ± 0.4 after laparoscopic myomectomy, 1.4 ± 0.2 after laparotomic myomectomy, 2.4 ± 0.7 after hysteroscopic resection, 1.4 ± 0.7 after no treatment, and 2.1 ± 0.3 after UAE. Mean number of embryo per patient was 3.8 ± 0.1 after laparoscopic myomectomy, 3.7 ± 0.5 after laparotomic myomectomy, 2.8 ± 0.6 after hysteroscopic resection, 2.7 ± 0.2 after no treatment, and 2.2 ± 0.7 after UAE. Cumulative pregnancy rate was 28.0% after laparoscopic myomectomy, 21.0% after laparotomic myomectomy, 12.0% after hysteroscopic resection, 18.3% after no treatment, and 4.6% after UAE. The take-home baby rate was 30.0% after laparoscopic myomectomy, 23.8% after laparotomic myomectomy, 18.2% after hysteroscopic resection, 16.7% after no treatment, and 4.8% after UAE. Conclusion. The efficacy of IVF and embryo transfer after treatment for uterine fibroids is determined by numerous factors, including age, ovarian reserve, size of fibroids, methods used for treatment of uterine fibroids, time between surgical treatment and IVF and embryo transfer. In women planning pregnancy and treatment of uterine fibroids by uterine artery embolization, especially over 35 years of age, it is advisable to use IVF protocols for cryopreservation of oocytes or embryos before surgery. Key words: infertility and uterine fibroids, uterine fibroids and IVF, myomectomy and IVF, uterine artery embolization, efficiency of IVF and embryo transfer

2538 Current Methods of Tissue Extraction in Minimally Invasive Surgical Treatment of Uterine Fibroids

Study Objective Since the 2014 Food and Drug Administration warnings regarding the use of power morcellation, gynecologists have adopted multiple alternative tissue extraction strategies. The objective of this study is to investigate the current techniques used by minimally invasive gynecologic surgeons for tissue extraction following minimally invasive hysterectomy for fibroids. Design Web-based survey. Setting N/a Patients or Participants Current AAGL members were sent a link to access the survey, which was available from March 26, 2019 to April 17, 2019. Interventions N/a. Measurements and Main Results 420 respondents completed the survey. The most common methods of tissue extraction were manual morcellation through the colpotomy (72.4%) and mini-laparotomy (66.9%). 31.7% of all participants endorsed the use of power morcellation. Intact specimen removal through a laparotomy was reported by 10% of respondents. Other methods of tissue extraction, such as intra-abdominal manual morcellation with a laparoscopic scalpel, were reported by 1.4%. Use of containment bags was reported by 43.4% during vaginal morcellation, 83.6% during mini-laparotomy, and 56.8% during power morcellation. Mini-laparotomies were on average 3.5cm and most commonly located at the umbilicus. Geographic differences were seen with respect to power morcellation, with 18.4% of US-based surgeons reporting its use compared to 56.9% of non-US-based surgeons. Conclusion Minimally invasive gynecologic surgeons are currently employing a variety of tissue extraction strategies for hysterectomy for fibroids. A large majority of practitioners are performing manual morcellation through the colpotomy and/or mini-laparotomy; use of containment bags is more common with during mini-laparotomy than via colpotomy. Power morcellation is still in use, less commonly in the United States than in other countries, and usually within a containment system.

Clinical Utility Of Elagolix As An Oral Treatment For Women With Uterine Fibroids: A Short Report On The Emerging Efficacy Data.

Uterine fibroids (UFs) are the most common gynaecological benign disease. Even though often asymptomatic, UFs can worsen women’s health and their quality of life, causing heavy bleeding and anaemia, pelvic discomfort and reduced fertility. Surgical treatment of UFs could be limited by its invasiveness and the desire to preserve fertility. Thus, effective medical therapies for the management of this condition are needed. Common drugs used to control bleeding, such us hormonal contraceptive or levonorgestrel-releasing intrauterine system, have no effect on fibroids volume. Among other more efficient treatments, the gonadotropin-releasing hormone (GnRH) agonist or the selective progesterone-receptor modulators have a non-neutral safety profile; thus, they are used for limited periods or for cyclic treatments. Elagolix is a potent, orally bioavailable, non-peptide GnRH antagonist that acts by a competitive block of the GnRH receptor. The biological effect is a dose-dependent inhibition of gonadal axis, without a total suppression of estradiol concentrations. For this reason, even though comparative studies between elagolix and GnRH agonists have not been performed, elagolix has been associated with a better profile of adverse events. Recently, elagolix received US FDA approval for the treatment of moderate to severe pain caused by endometriosis. Several clinical trials assessed the efficacy of elagolix for the treatment of heavy bleeding caused by UFs and the definitive results of Phase III studies are expected. Available data on elagolix and UFs showed that the drug, with or without low-dose hormone add-back therapy, is able to significantly reduce menstrual blood loss, lead to amenorrhea and improve haemoglobin concentrations in the majority of participants in comparison with placebo. The safety and tolerability profile appeared generally acceptable. The concomitant use of add-back therapy can prevent bone loss due to the hypoestrogenic effect and can improve safety during elagolix treatment.

Возможности применения рентгеноэндохирургического гемостаза в комплексной терапии миомы матки у пациенток с тяжелой анемией

Uterine fibroids is one of the most common benign tumors of the pelvic organs in women. Up to 20% of women over 35 and up to 40% of women over 50 have this disease. The socio-medical significance of uterine fibroids is due to: rejuvenation of the disease, late diagnosis and treatment, which lead to complications resulting in emergency surgical interventions, the likelihood of tumor recurrence after primary surgery, which leads to a violation of generative function and reduce the quality of life of women. In planned gynecological hospitals, surgery for uterine fibroids is performed in more than 50% of patients. Of the total number of gynecological medical services in the emergency room, urgent gynecological care accounts for between 26% and 40%. Uterine bleeding remains one of the urgent problems in emergency gynecology, and in the structure of causes of mortality is 18-23%. Bleeding is one of the main symptoms of uterine fibroids. In urgent situations, the main task is to quickly and effectively stop bleeding and its prevention. Conservative methods to stop bleeding, hormone therapy and a minimal-ly invasive method - hysteroscopy followed by curettage of the uterine mucosa does not always lead to the desired result with large sizes of myoma nodes, as well as with multiple uterine myoma. Conservative myomectomy belongs to the category of reconstructive plastic surgery and is associated with higher risks of peri- and postoperative complications than radical interventions. Naturally, in an emergency situation, in a serious condition of the patient, severe anemia, hysterectomy is performed more often than myomectomy. In the available foreign and domestic literature there are very few works devoted to a comprehensive assessment of the possibility of organ-preserving surgical treatment of uterine fibroids in urgent gynecology. The lack of consensus about the tactics of management of patients of reproductive age with uterine myoma when providing emergency gynecological care, analyzing the results of surgical treatment for reproductive function does not allow to develop a single algorithm for managing patients, both in the operative and postoperative periods, putting this problem among the current.

Surgical treatment of uterine fibroids: current state of the problem and own experience

Uterine myomas are the commonest gynecological tumors, with a prevalence of 70% to 80% in women who have reached the age of 50 years. In the contingent of women aged 25 to 44 years, the incidence is 8.9-30.9/1000. The prevalence of uterine myomas increases with age, peaking in women in 40 years. A hysterectomy study has found myomas in 77% of uterine specimens. In many women myomas may be asymptomatic and are diagnosed incidentally on clinical examination or imaging. However, myomas can cause significant morbidity including menstrual abnormalities (e.g. heavy, irregular, and prolonged uterine bleeding), iron deficiency anemia, bulk symptoms (e.g. pelvic pressure/pain, obstructive symptoms), and fertility issues. Symptomatic fibroids have a considerable impact on women's quality of life as well as their productivity. The article describes an overview of modern surgical methods for treating of uterine myomas. The advantages and disadvantages of each surgical method, indications and contraindications to their use are analyzed and described. Modern minimally invasive techniques for the treatment of uterine fibroids, such as uterine artery embolization and the use of focused energy delivery systems, are described. The clinical case of nodal symptomatic uterine myoma with necrosis of the fibromatous node in a patient treated in the Military Medical Clinical Center of the Central Region is given. The patient performed extirpation of the uterus with left appendages, right uterine tube.

Ovarian blood supply in women of reproductive age and echo-graphic evaluation of influence of subtotal hysterectomy on it

Purpose of the study . To study the peculiarities of ovarian blood supply after subtotal hysterectomy in the reproductive age. Materials and methods of research . In accordance with the purpose and objectives of the work 150 women of reproductive age were included, there were 4 groups. 125 patients suffered from uterine leiomyoma, 100 of whom had a hysterectomy (HE) – a supravaginal uterus amputation (SUA), which corresponds to a subtotal HE (SHE). Results . When examining a group of healthy women of the control group, we determined the average volume of the ovaries – 5.2 ± 0.2 cm 2 , which did not differ from the average size for healthy women of reproductive age. When studying the structure of the ovaries and their size, several large ovarian dimensions (6.0 ± 0.4 cm 2 ) and the presence of cystic changes in some of them have attracted attention in patients with leiomyoma of the uterus. In addition to the study of the anatomical characteristics of the ovaries, we investigated the blood flow in the ovarian arteries, and the study of blood flow was carried out according to the phases of the menstrual cycle in the women of the control group, as well as in patients with uterine leiomyoma – one year before and after the operation. Conclusions. Ultrasound showed a gradual decrease in volume as the duration of the postoperative period increased. Duplex scanning with the determination of indices characterizing the blood flow revealed a slight deterioration in the blood supply of the ovaries within 1 year after removal of the uterus compared with patients with uterine leiomyoma and healthy women of similar age. IER was the most sensitive index, which was the first to react to the change in the tone of the vascular bed. In more than half of operated patients we did not find any cyclic changes in the blood flow in the ovarian artery, which was characteristic of healthy patients of reproductive age. Change in blood flow is early and more sensitive sign of impaired ovarian function. Cystic ovarian changes, found in 2.5 % of patients with uterine leiomyoma after SHE, were combined with a sharp suppression of the blood flow, which allowed us to assert that cystic ovarian changes, in fact, are the cystic degeneration against the background of severe ischemia of the organ. The results obtained should be taken into account when developing an algorithm for managing patients after surgical treatment of uterine fibroids in the volume of the SHE.

123 - Change in Surgical Practice for Women With Fibroids Following the FDA Safety Communication on Morcellation

Study Objective: To evaluate changes in the use of laparoscopy for surgical treatment of uterine fibroids following the FDA safety communication on tissue morcellation.

Новые аспекты в лечении лейомиомы матки, ассоциированной с эндометриозом

Despite the high level of development of modern surgery and pharmacology, none of the surgical techniques (hysterectomy / myometectomy or embolization of the uterine arteries) or drug therapy is not a guarantee of the absence of a future recurrence of uterine fibroids and endometriosis. However, there are methods of effective pharmacotherapy for their manifestations. In particular, selective progesterone receptor modulators (SMPR) demonstrate high efficacy in respect of the symptoms of myoma and the size of the nodes, which allows them to be considered as a complete alternative to the surgical treatment of uterine fibroids. The objective: evaluation of the effectiveness of the use of SMPR in the treatment of combined gynecological diseases. Patients and methods. The study included materials for the observation of 40 women 20–52 years old with uterine myoma against the background of combined gynecological pathology (endometriosis, infertility), which carried out the enucleation of myomatous nodes by laparotomy, laparoscopic or transcervical access. Patients were divided into two groups. In the main group (n=20), women received SMPR – ulipristal acetate (UPA) 5 mg daily for 3 months. The UIA's bioavailability is 70%. The optimal therapeutic single dose for the analyzed pathology is 5 mg. After 3 months, the first assessment of the effectiveness of the drug with combined gynecological pathology was conducted, then 14 women were exposed to surgical treatment, and 6 of 20 patients continued conservative treatment for another 1–4 months. After the operation to prevent the recurrence of uterine fibroids and endometriosis, 8 patients continued treatment of UPA for 4 months. In the comparison group (n=20), women underwent surgical treatment at similar rates, but the SMPR was not assigned to surgery. Results. Of the studies indicate that the use of such a selective modulator of progesterone receptors, like vandalite acetate, in the treatment of uterine myomas in combination with endometriosis is safe and well tolerated, leads to rapid persistent coping of uterine bleeding, a significant decrease in the size of nodes and foci of endometriosis, and the achieved The therapeutic effect is maintained even after the abolition of therapy. Conclusion. Thus, the use of the drug ulipristal acetate in the treatment of uterine fibroate on the background of combined gynecologic pathology is highly effective and promising as an independent and integrated treatment method of this category of patients. Key words: uterine myoma, endometriosis, selective modulators of progesterone receptors, viperpatel acetate, combined oral contraceptives.

ОЦІНКА ЯКОСТІ ЖИТТЯ У ЖІНОК ІЗ ФІБРОМІОМОЮ МАТКИ ДО ТА ПІСЛЯ ОПЕРАТИВНОГО ЛІКУВАННЯ.

Досвід показує, що у жінок з міомою матки підвищений рівень тривожності, а це може призвести до зниження активності і якості життя, а в подальшому до соціальної та особистої ізоляції в період оперативного лікування. У зв’язку з цим оцінка якості життя пацієнток в наш час набуває все більшого значення поряд з основними традиційними методиками оцінки ефективності лікування та наслідків захворюваності. За отриманими результатами, якість життя у жінок репродуктивного та пострепродуктивного віку, які перенесли оперативне лікування з приводу міоми матки, на основі запропонованої нами терапії покращилася.

Surgical Treatment of Uterine Fibroids Within a Containment System and Without Power Morcellation.

Increased awareness regarding risks associated with intracorporeal electromechanical, or power, morcellation has urged surgeons to develop alternative methods for tissue extraction that may mitigate some of these risks during surgery. The use of containment systems during laparoscopic procedures has allowed surgeons to continue to offer and perform myomectomies that still benefit from being minimally invasive but which may minimize the risk of inadvertent tissue dispersion. Here, we will review techniques for performing contained tissue fragmentation without the use of a power morcellator.

Расширение возможностей органосохраняющего лечения миомы матки с использованием улипристала ацетата

The choice of treatment of uterine leiomyoma affects different factors: the intensity of the symptoms of fibroids characteristics, age and the need for preservation of the uterus (and fertility). The use of ulipristal acetate may change the orientation of the surgical treatment of uterine fibroids.

New era in treatment of uterine fibroids in women of different age groups

Despite the high level of development of modern surgery and pharmacology, none of surgical procedures (hysterectomy/myomectomy or uterine artery embolization) or the drug does not guarantee the absence of recurrence of uterine fibroids in the future. However, there are quite effective methods of pharmacotherapy its manifestations. In particular, selective progesterone receptor modulators show high effectiveness against the symptoms of fibroids and sizes nodes, which allows us to consider them as a full fledged alternative to surgical treatment of uterine fibroids. The results of PEARL-I, -II, -III studies show that the use of such a selective progesterone receptor modulator as ulipristal acetate in treating symptomatic uterine fibroids is safe and well tolerated, leading to rapid cupping uterine bleeding nodes, greatly reduces the size and the therapeutic effect is maintained even after therapy discontinuation.