Endometrial dating sternberg
Endometrial dating sternberg
Moreover, affected women frequently report dysmenorrhea, dyspareunia, non-cyclic pelvic pain and urinary symptoms (ie, bladder tenesmus).As one can easily infer, uterine fibroids can negatively affect a woman’s quality of life and work productivity.
According to clinical data, UPA shows several advantages: it is faster than leuprolide in reducing the fibroid-associated bleeding, it significantly improves hemoglobin and hematocrit levels in anemic patients, and it grants a significant reduction in the size of fibroids, which lasts for at least 6 months after the end of the treatment.Several risk factors have been identified, such as ethnicity, nulliparity, genetics, and hormonal factors.Symptomatic women typically suffer from abnormal uterine bleeding, which is usually heavy and prolonged and hence results in anemia.In a recent paper, 53.7% women reported a dramatic decline in their quality of life, due to a general impairment in sexual life (42.9%), work productivity (27.7%), as well as family and daily life (27.2%).6This review analyses clinical studies on the use of ulipristal acetate (UPA), an oral selective progesterone modulator (SPRM), for the pharmacological management of uterine fibroids.UPA may be a new, effective, and well-tolerated option for the preoperative treatment of moderate and severe symptoms in reproductive age women.They are considered the most common benign tumors of the female genital tract, as they are clinically apparent in up to 25% of women irrespective of their age.
Moreover, they occur in up to 30%–40% of women over the age of 40.1 The reported incidence ranges from 30% to 70% in premenopausal women and increases with age.2 Both the etiology and biology of uterine fibroids are poorly understood, but strong evidence supports the role of hormonal factors (estrogens and progestogens) in favoring tumor growth.3–4 Myomas rarely appear before menarche5 and frequently regress after menopause.Selective progesterone-receptor modulators (SPRMs) are a new class of PR ligands displaying tissue-selective agonist/antagonist/mixed activity on target cells.18 UPA is an orally active synthetic SPRM, characterized by a tissue-specific partial progesterone antagonist effect.19Progesterone normally promotes fibroid growth in two ways: on the one hand, it up regulates epidermal growth factor (EGF) and Bcl-2 gene, on the other hand it down regulates the tumor necrosis factor gene (TNF).UPA, as a progesterone antagonist, inhibits the proliferation of leiomyoma cells and induces apoptosis by increasing cleaved caspase-3 expression and decreasing Bcl-2 expression.17 Moreover, UPA down regulates the expression of angiogenic growth factors, such as vascular endothelial growth factor (VEGF) and their receptors.In addition to that, no randomized controlled trial has proven that the benefits of danazol outweigh its risks, when treating uterine fibroids.7 The use of a levonorgestrel intrauterine device (LNG-IUS) has been associated with a reduction in menstrual blood loss in women with uterine myomas, but its effect on the size of uterine myoma is still debated.8 LNG-IUS is contraindicated in the case of fibroid-associated severe distortion of the uterine cavity (LNG-IUS Sm PC), because of the high expulsion rate.8–10Furthermore, gonadotropin-releasing hormone analogs (Gn RHa) proved to be successful both as a conservative treatment and as a preoperative therapy of myomas.They are highly effective in reducing both the symptoms (bleeding, anemia, and abdominal pain) and the volume of fibroids.11,12 However, these effects are transient and the myomas usually return to pre-therapy size within a few months of discontinuation.On the grounds of this evidence, the administration of 5 mg/day ulipristal acetate for 3 months is suggested for different patient categories and allows for planning a treatment strategy tailored to meet an individual patient’s needs.