Preoperative medication in patients with uterine myoma: expediency and effectiveness
The objective. To study the effectiveness of ulipristal as preoperative medication in patients with uterine myoma prepared for planned myomectomy. Patients and methods. 34 patients aged 22 to 43 years (mean age - 29.3 ± 2.4 years) were examined. The size of the uterus varied from 7 to 14 wks of conditional pregnancy, on the average 9.8 ± 2.1 wks. The duration of disease varied from 4 months to 6 years, on the average 2.8 ± 1.6 years. In all (100%) cases, transvaginal ultrasound scanning was used as an additional method of diagnosing myoma of the uterus, in 16 (47.05%) - hysteroscopy and in 11 (32.3%) - magnetic resonance tomography. Taking into account the findings of complex examination, the following types of myoma of the uterus were diagnosed: type 0 - 4 (11.7%) cases; type 1 - 6 (17.6%); type 2 - 9 (26.5%); types 3-5 - 11 (32.3%); in 4 (11.7%) patients of reproductive age a single myomatous nodule with hybrid localisation was diagnosed belonging to types 2-5 (simultaneous deformity of the endometrial contours and the serosal covering of the uterus). Ulipristal was administered 5 mg (1 tablet) daily internally irrespective of intake of meals. In 24 (70.6%) patients therapy lasted for 24 wks (2 courses, 12 wks each), in 10 (29.4%) - 12 wks. Results. The cessation of menstruation associated with intake of ulipristal was noted in 28 (82.3%) women: 87.5% among patients with a repeat 3-month course of therapy and 70% - with a single 3-month course of treatment. A decrease of the volume of myomatous nodules was noted in 30 of 34 (88.2%) patients. A clinically significant (>25%) decrease, however, was recorded in 14 (41.2%). After a repeat 3-month course of ulipristal therapy this index reached 45.8% (11 of 24), and after a single course of treatment - 30% (3 of 10). In 5 observations (14.7%) the volume of myomatous nodules decreased by 40-42%. Conclusion. In «complex» uterine myomas, the success of organ-sparing surgical treatment in many respects depends on the quality of preoperative medication preparing patients for surgery. For these purposes, the use of drugs is justified, the mechanism of antiproliferative activity of which can be explained from the positions of the pathogenesis of the growth of leiomyoma - selective progesteron receptor modulators.