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Abstract

Conservative Management of uterine fibroids

Until now the success rate of medical treatment of uterine fibroids with the available drugs was limited. Tranexamic acid, progestins and oral contraceptives are only useful in the treatment of bleedings disorders, but have no influence on the growth of fibroids. The levonorgestrel-IUS (Mirena®), which is contraindicated in submucous fibroids, can be used for the treatment of bleeding disorders, but has no effect on the size of fibroids or any other symptoms. Until now only GnRH-analogue has a license for the medical treatment of fibroids. GnRH-analogue decrease the serum estradiol level and that leads to a reduction of the volumen of the fibroids of 50 % on average. The maximal duration of treatment is six months. An add-back treatment is often necessary, because the patients suffering from hot flushes. Progesteron receptor modulators, like mifepristone, asoprisnil or telapriston, showed good effects on fibroids in clinical studies, but they have al lot of relevant side effects (pathological endometrial findings or negative effects to the liver metabolism). Since more than one year ulipristalacetat (UPA, Esmya®) is in Germany available. UPA was tested in a clinical development program in comparison to placebo and also GnRH-analogues. The superiority of UPA in comparison to placebo was significantly demonstrated. In comparison to GnRHanalogues the efficacy of UPA was equal, but the number of side effects was significantly lower. The effects of the reduction of the fibroids substained until six months after the end of the treatment. Until now UPA has a label for the treatment of patients sufferings from fibroids and in which a surgical procedure is planned. On the basic of these data and the clinical experiences UPA has replaced GnRH-analogues in medical treatment of fibroids.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(1): 62–75

Keywords
Fibroids, medical treatment, GnRH-analogue, ulipristalacetat

Thomas Römer
Evangelisches Krankenhaus Köln-Weyertal, Köln
Reviewer: Matthias David, Berlin,
und Alexander Mustea, Greifswald

Römer T. Konservative ... Gynakol Geburtsmed Gynakol Endokrinol 2014; 10(1): 62–75 publiziert 31.03.2014 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2014 ISSN 1614-8533