Comparing the Outcome of Ullipristal Acetate and Mifepristone in the Medical Management of Uterine Fibroids

Introduction: Uterine leiomyomas are widely prevalent and frequently cause menorrhagia. The major therapeutic option today is hysterectomy. Medical options are of highest interest. Aim& Objectives: Efficacy and safety of mifepristone in medical management of myoma and to compare two doses - 10 vs.25 mg/day versus ullipristal acetate 5mg/day. Materials& Methods: study period from January 2016 to january 2018. A total of 150 women with uterine leiomyomas randomized to receive 10mg, 25 mg mifepristone Group 1: Patients were randomized and were given oral mifepristone as 25 mg/day in group 1 for 3 months Group 2: oral mifepristone 10 mg/day in group 2 for 3 months. GROUP 3: Patient s were randomized and given ulliprisstal acetate 5mg/day for 3 months All Patients were followed at 1, 3 and 6 months. Haemogram, liver function test, ultrasound with doppler and endometrial histology was performed. . Uterine blood flow and leiomyoma volume were evaluated Endometrial biopsies were obtained prior to and at end of treatment. Relevant biochemistry, symptoms and bleeding were recorded. Primary outcome was reduction in uterine leiomyoma size. Results: There was a significant decrease in the total leiomyoma volume in the mifepristone-treated group, Mifepristone treatment significantly reduced the bleeding days and increased serum haemoglobin values. Serum cortisol levels remained unchanged, while a mild increase in serum androgens was noted. Endometrial biopsies showed no premalignant changes or changes in mitotic indices.1. Comparing the fibroid size in volume between three groups ANOVA test results in a statistically significant difference between the three groups with P-value less than 0.05. Post-hoc tests confirm that there is statistically significant difference between i. Group 1& Group 2; An average reduction of fibroid size by 51 % more in Group 1 as compared to Group 2 ii. Group 1& Group 3; An average reduction of fibroid size by 74 % more in Group 1 as compared to Group 3 Patients on ullipristal acetate showed minimal reduction of fibroid with menorrhagia or spotting during the treatment with 10 patients with deranged liver function test. Conclusion: Mifepristone offers an effective treatment option for women with uterine leiomyoma and the associated pronounced uterovaginal bleeding.