Ulipristal Acetate Effectively Medically Manages Symptomatic Leiomyomatous Uteri

Background: Symptomatic leiomyomatous uteri affect about 30% of women. Associated anemia, dysmenorrhea, dyspareunia, heavy menstrual bleeding, and mass effects cause quality of life decrements. The 5-year levonorgestrel intrauterine device (5yr-IUD) has been a mainstay of medical management for symptomatic leiomyomata. If approved, Ulipristal acetate (UPA), which entered the European and Canadian markets in 2012 and 2013, could change medical management of symptomatic leiomyomata in the United States. Methods: PubMed search for the term “ulipristal acetate treatment fibroids” yielded five included articles. Hand search provided nine additional articles. Results: The 5yr-IUD achieves maximal amenorrhea in 70% of users at 3 months. Dysmenorrhea improves in 84% of 5yrIUD users. A Phase III trial with 451 participants compared UPA 5 and 10 mg over four 12-week treatment cycles. At the study end, menstruation was controlled in up to 77.5% of participants, with 70% or more participants in each group achieving amenorrhea. Combined median leiomyoma volume reduction for the three largest leiomyomata reached 67.4%. Median health related QOL scores decreased from 56.9 and 55.2 respectively to 20.7 and 15.5 respectively after the fourth treatment cycle. Conclusion: UPA offers onset amenorrhea within 6 days irrespective of dose, whereas the 5yr-IUD may take 3-months to achieve amenorrhea. UPA decreases leiomyomata volume up to 65% within 1-year, but, the 5yr-IUD does not reduce leiomyomata volume. The 5yr-IUD provides simultaneous contraception, whereas UPA requires separate contraception. As there are no significant benefits to higher dose treatment, UPA 5 mg should have a place in gynecologic clinical practice.