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https://read.qxmd.com/read/30774352/uterine-fibroids-an-update-on-current-and-emerging-medical-treatment-options
#1
REVIEW
Manuela Farris, Carlo Bastianelli, Elena Rosato, Ivo Brosens, Giuseppe Benagiano
Uterine fibroids are the most common gynecological disorder, classically requiring surgery when symptomatic. Although attempts at finding a nonsurgical cure date back to centuries, it is only around the middle of the last century that serious attempts at a medical treatment were carried out. Initially, both progestins and estrogen-progestin combinations have been utilized, although proof of their usefulness is lacking. A major step forward was achieved when peptide analogs of the GnRH were introduced, first those with superagonist properties and subsequently those acting as antagonists...
2019: Therapeutics and Clinical Risk Management
https://read.qxmd.com/read/30741799/ulipristal-acetate-for-disseminated-peritoneal-leiomyomatosis
#2
Samantha Benlolo, Jessica Papillon-Smith, Ally Murji
BACKGROUND: Disseminated peritoneal leiomyomatosis is a rare condition manifesting as hormone-sensitive soft tissue nodules lining the peritoneal cavity. Given the extensiveness of this disease, surgical management is challenging, making hormonal suppression the primary treatment. CASE: A 23-year-old woman presenting with abdominal pain was found to have innumerable abdominopelvic nodules on imaging. Biopsy of these lesions was consistent with disseminated peritoneal leiomyomatosis...
February 4, 2019: Obstetrics and Gynecology
https://read.qxmd.com/read/30702466/pathologic-changes-in-uterine-leiomyomas-after-extended-treatment-with-ulipristal-acetate
#3
Martin C Chang, Eleanor Latta
Ulipristal acetate is a selective progesterone receptor modulator that acts on progesterone receptors in uterine muscle and endometrium. It is effective in reducing the size of uterine leiomyomas (fibroids) and in managing associated menorrhagia. Although ulipristal acetate-associated pathologic changes have been previously documented in the endometrium, it is unclear what morphology can be expected in posttreatment fibroids. We herein report 2 cases in which patients underwent hysterectomy, after at least two 3-mo courses of ulipristal acetate...
January 29, 2019: International Journal of Gynecological Pathology
https://read.qxmd.com/read/30675965/adverse-symptoms-during-short-term-use-of-ulipristal-acetate-in-women-with-uterine-myomas-and-or-adenomyosis
#4
Yeon Hee Hong, Soo Jin Han, Dayong Lee, Seul Ki Kim, Byung Chul Jee
AIM: To evaluate various adverse symptoms during short-term use of ulipristal acetate in women with uterine myomas (n = 90), adenomyosis (n = 3) or both (n = 7). METHODS: One hundred premenopausal women who received ulipristal acetate for 4-12 weeks during 2016 to 2017 were selected. The medical records were reviewed and the following information was collected; adverse symptoms during medication, presence of menorrhagia or menstrual cramps, blood hemoglobin and liver function test...
January 24, 2019: Journal of Obstetrics and Gynaecology Research
https://read.qxmd.com/read/30669160/birth-control-pills-and-thrombotic-risks-differences-of-contraception-methods-with-and-without-estrogen
#5
Hannelore Rott
In Germany one-third of the women in fertile age use combined oral contraceptives (COCs), which consist mostly of ethinylestradiol (EE) and a synthetic progestin. Older COCs with norethisterone or levonorgestrel have a lower risk for venous thromboembolism (VTE) than newer COCs with desogestrel, drospirenone, or gestodene. This is also true for nonoral combined hormonal contraceptives. The risk of newer COCs containing estradiol instead of EE is not clear due to missing data. Progestin-only hormonal contraception is not associated with a significant increase of the risk for VTE with the exception of depot medroxyprogesterone acetate...
January 22, 2019: Hämostaseologie
https://read.qxmd.com/read/30661244/interventions-for-emergency-contraception
#6
REVIEW
Jie Shen, Yan Che, Emily Showell, Ke Chen, Linan Cheng
BACKGROUND: Emergency contraception (EC) is using a drug or copper intrauterine device (Cu-IUD) to prevent pregnancy shortly after unprotected intercourse. Several interventions are available for EC. Information on the comparative effectiveness, safety and convenience of these methods is crucial for reproductive healthcare providers and the women they serve. This is an update of a review previously published in 2009 and 2012. OBJECTIVES: To determine which EC method following unprotected intercourse is the most effective, safe and convenient to prevent pregnancy...
January 20, 2019: Cochrane Database of Systematic Reviews
https://read.qxmd.com/read/30632825/potential-synergism-between-ulipristal-acetate-and-vitamin-d3-in-uterine-fibroid-pharmacotherapy-2-case-studies
#7
Michał Ciebiera, Błażej Męczekalski, Krzysztof Łukaszuk, Grzegorz Jakiel
This is a preliminary report of the first cases of successful simultaneous use of ulipristal acetate (UPA) and vitamin D3 in uterine fibroid (UF) oral treatment in humans. We present two cases of 37- and 49-year-old females with clinically symptomatic UFs and vitamin D deficiency. Both patients were treated with a standard 3 months of UPA scheme (5 mg daily) with the additional use of vitamin D3 (7000 IU daily orally). In the 37-year-old female all the symptoms (pain, pressure, frequent urination) decreased, total tumor volume after the treatment changed by 47...
January 11, 2019: Gynecological Endocrinology
https://read.qxmd.com/read/30629378/-pharmacovigilance-update
#8
Christopher Abo Loha, Françoise Livio
The main pharmacovigilance updates in 2018 are reviewed. Quinolones : no longer recommended for mild or moderately severe infections. Denosumab in cancer patients: increased risk of new primary malignancies. Cyproterone : increased risk of meningioma at high dose. Saccharomyces boulardii : risk of fungemia in frail patients. Ulipristal : risk of hepatotoxicity. Daclizumab : early withdrawal from the market as risks clearly outweigh benefits. Interactions between boosted antiretrovirals and anti-P2Y12 : prasugrel appears as the best option...
January 9, 2019: Revue Médicale Suisse
https://read.qxmd.com/read/30614295/prevention-of-unintended-pregnancies-by-using-emergency-contraception-the-differences-between-levonorgestrel-and-ulipristal-acetate-a-theoretical-model-using-data-from-a-survey-on-the-use-of-emergency-contraception-in-spain-2017
#9
Iñaki Lete, José Luis Doval, Ezequiel Pérez-Campos, María Jesús Alonso, Guillermo Sellers, Rafael Sánchez-Borrego
OBJECTIVE: To estimate the differences in unintended pregnancies avoided using either levonorgestrel (LNG) or ulipristal acetate (UPA) emergency contraception (EC). DESIGN: Cross-sectional study. SETTING: Survey carried out in Spain. PARTICIPANTS: 1000 Spanish women reporting unprotected sex in 2017. MAIN MEASUREMENTS: EC use, reasons for not using EC, calculation of the number of unintended pregnancies avoided...
January 7, 2019: Gynecological Endocrinology
https://read.qxmd.com/read/30601065/fibroid-management-in-premenopausal-women
#10
J Donnez, G E Courtoy, M-M Dolmans
Uterine fibroids are the most common tumors affecting premenopausal women, responsible for bleeding, pain, and reduced quality of life. When symptomatic, their management mainly involves surgery, which is all too often radical (hysterectomy). While surgical options sparing the uterus (hysteroscopic and laparoscopic myomectomy) and other non-surgical approaches do indeed exist, drug-based therapies are associated with lower costs and morbidity rates. Since progesterone is required for fibroid growth, gonadotropin agonists have been used to control bleeding and decrease fibroid volume, but they only represent a temporary remedy due to adverse events...
January 2, 2019: Climacteric: the Journal of the International Menopause Society
https://read.qxmd.com/read/30567472/ulipristal-acetate-mediates-decreased-proteoglycan-expression-through-regulation-of-nuclear-factor-of-activated-t-cells-nfat5
#11
Joy L Britten, Minnie Malik, Terrence D Lewis, William H Catherino
Nuclear factor of activated T-cells (NFAT5) is a tissue specific, osmoadaptive transcription factor essential for the control of hydration homeostasis in mammalian cells. Nuclear factor of activated T-cells regulates osmolyte transporters aldo-keto reductase family 1 member B1 (AKR1B1) and solute carrier family 5 member 3 (SLC5A3) to maintain fluid equilibrium in cells. The osmotic potential of the extracellular matrix of leiomyomas is attributed to the role of proteoglycans. In leiomyoma cells, NFAT5 is overexpressed compared to myometrial cells...
December 19, 2018: Reproductive Sciences
https://read.qxmd.com/read/30554215/ulipristal-acetate-before-hysteroscopic-and-laparoscopic-surgery-for-uterine-myomas-help-or-hindrance
#12
REVIEW
Simone Ferrero, Valerio Gaetano Vellone, Fabio Barra, Carolina Scala
BACKGROUND/AIMS: Ulipristal acetate ([UPA], Esmya®) is an orally active selective progesterone-receptor modulator that has been approved as preoperative treatment for uterine myomas. This systematic review aims to summarize the available data on surgical outcomes of patients undergoing myomectomy by hysteroscopy or by laparoscopy after preoperative treatment with UPA. METHODS: this review was performed following PRISMA guidelines and was registered in PROSPERO (CRD42018092201)...
December 14, 2018: Gynecologic and Obstetric Investigation
https://read.qxmd.com/read/30539001/selective-progesterone-receptor-modulators-for-the-medical-treatment-of-uterine-fibroids-with-a-focus-on-ulipristal-acetate
#13
Thomas Rabe, Nicole Saenger, Andreas D Ebert, Thomas Roemer, Hans-Rudolf Tinneberg, Rudy Leon De Wilde, Markus Wallwiener
Uterine fibroids are the most frequent benign tumours in women of child-bearing age. Their symptoms are diverse and the quality of life of the women affected can be significantly impaired. While treatment to date has been primarily by means of surgical intervention, selective progesterone receptor modulators (SPRMs) open up new medication-based treatment options. EMA's Pharmacovigilance Risk Assessment Committee (PRAC) has recently completed its review of ESMYA® (ulipristal acetate, 5 mg), following reports of serious liver injury, including liver failure leading to transplantation in postmarketing settings...
2018: BioMed Research International
https://read.qxmd.com/read/30515219/therapy-with-ulipristal-acetate-in-a-hypertensive-patient
#14
A Alcalde Dominguez, J Rabasa Antonijuan, M Cusidó Gimferrer, M Jiménez Ortuño
Ulipristal acetate (UPA) is a medical therapy for patients with symptomatic uterine fibroids. The drug has shown efficacy in the control of heavy menstrual bleeding and, as a consequence, in anaemia improvement. We report the case of a hypertensive patient treated with two courses of UPA. In addition to its observed benefits on hypermenorrhea caused by uterine fibroids, no exacerbation of the underlying disease was observed. No adverse effects were observed, and blood pressure levels were well controlled throughout...
2018: Case Reports in Medicine
https://read.qxmd.com/read/30514160/1-25-dihydroxyvitamin-d3-enhances-the-antifibroid-effects-of-ulipristal-acetate-in-human-uterine-fibroids
#15
Mohamed Ali, Sara Mahmoud Shahin, Nagwa Ali Sabri, Ayman Al-Hendy, Qiwei Yang
BACKGROUND: Both European and American trials showed superior effect of ulipristal acetate (UPA) to placebo. However, the latter, which included black patients with known higher vitaminD3 deficiency risk, showed lower rate of amenorrhea responders and insignificant uterine fibroid (UF) size reduction. Our objective is to investigate whether adding vitamin D3 to UPA can enhance UPA potency on UF phenotype in vitro. METHODS: We screened the antiproliferative effect of different (UPA/vitaminD3) combinations on UF cell proliferation using dimethylthiazolyl diphenyltetrazolium bromide assay...
December 4, 2018: Reproductive Sciences
https://read.qxmd.com/read/30468982/sonographic-and-hysteroscopic-endometrial-examination-in-women-treated-with-ulipristal-acetate-exploratory-findings-at-a-tertiary-referral-center
#16
Meritxell Gracia, Roser Nonell, Cristina Ros, Mariona Rius, Lara Quintas, Maria Ángeles Martínez-Zamora, Francisco Carmona
OBJECTIVE: Ulipristal acetate (UPA) is a progesterone receptor modulator (PRM) agent that has shown benefits in women with symptomatic uterine fibroids. However, its effects on the endometrium are complex and not fully understood. We describe exploratory findings on macroscopic observation of the endometrium at transvaginal sonography (TVS) and hysteroscopy. The aim of the study is to characterize endometrial patterns commonly observed after UPA treatment. STUDY DESIGN: We performed a prospective longitudinal study at a tertiary referral center with 100 women with symptomatic uterine fibroids who received a 12-week treatment with UPA (5 mg/day)...
January 2019: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://read.qxmd.com/read/30460871/liver-safety-parameters-of-ulipristal-acetate-for-the-treatment-of-uterine-fibroids-a-comprehensive-review-of-the-clinical-development-program
#17
REVIEW
Jacques Donnez, Pablo Arriagada, Marcin Marciniak, Dominique Larrey
Uterine fibroids are benign tumors within the uterine wall affecting women. Ulipristal acetate 5 mg was first authorized in the European Union on 23 February 2012, with a post-marketing exposure estimated to be more than 765,000 patients so far. During the post-marketing experience, sporadic cases of liver injury and hepatic failure were reported. A detailed review of the clinical trials carried out in the development of ulipristal acetate 5 mg was undertaken to further assess the liver safety data reported during the clinical trials...
December 2018: Expert Opinion on Drug Safety
https://read.qxmd.com/read/30407750/discovery-of-vilaprisan-bay-1002670-a-highly-potent-and-selective-progesterone-receptor-modulator-optimized-for-gynecologic-therapies
#18
Carsten Möller, Wilhelm Bone, Arwed Cleve, Ulrich Klar, Andrea Rotgeri, Antje Rottmann, Marcus-Hillert Schultze-Mosgau, Andrea Wagenfeld, Wolfgang Schwede
Progesterone plays an important role in the female reproductive system. However, there is also evidence that gynecologic disorders/diseases such as uterine fibroids and endometriosis are progesterone-dependent. Steroidal and non-steroidal selective progesterone receptor modulators (SPRMs) have shown potential for the treatment of such diseases. Steroidal SPRMs, including mifepristone and ulipristal acetate, have proven effective in clinical trials. However, several steroidal SPRMs containing a dimethylamino substituent have been associated with elevated liver enzymes in patients...
November 6, 2018: ChemMedChem
https://read.qxmd.com/read/30399016/pericoital-contraception
#19
Erica P Cahill, Paul D Blumenthal
PURPOSE OF REVIEW: To evaluate the literature on repeat use of emergency contraception and pericoital approaches to contraception. RECENT FINDINGS: Women are very interested in an oral, on-demand contraceptive option, were one available. Ulipristal acetate and a combination of levonorgestrel (LNG) and meloxicam (a cyclo-oxygenase-2 inhibitor) both appear to be more effective at disrupting ovulation than LNG alone. Recent advisories from the United Kingdom regarding daily dosing of ulipristal for fibroids emphasize the need for more safety data...
December 2018: Current Opinion in Obstetrics & Gynecology
https://read.qxmd.com/read/30389544/-emergency-contraception-cngof-contraception-guidelines
#20
N Hamdaoui, C Cardinale, A Agostini
OBJECTIVES: Edit, by the French National College of Gynecologists and Obstetricians (CNGOF), recommendations based on the evidence available in the literature for the use in terms of effectiveness, safety and side effects of emergency contraception (EC). METHODS: A review of the literature was conducted by consulting Medline, Cochrane Library and international recommendations in French and English from January 1, 1979 to May 1, 2018. RESULTS: It is recommended to inform patients that EC is not 100% effective...
October 30, 2018: Gynecologie, Obstetrique, Fertilite & Senologie
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