Influence of ulipristal acetate therapy compared with uterine artery embolization on fibroid volume and vascularity indices assessed by three-dimensional ultrasound: prospective observational study

Abstract

Objective

Fibroid vascularisation assessed with three‐dimensional power Doppler ultrasound is a predictor for uterine fibroid growth: a prospective cohort study

“…Using 3D power Doppler ultrasound the present study confirmed the association between vascularisation of the fibroid and fibroid growth. Methods of recording a 3D PD volume, calculating fibroid volume and vascular assessment were similar in the present study as reported in other studies . In 3D PD there are several factors influencing PD indices which should be considered.…”

“…A few studies assessed fibroid volume and VIs after treatment. Czuczwar et al reported a decrease in fibroid volume and VIs after 3 months of ulipristal therapy. In the study by Chia et al 2 months of gonadotrophin‐releasing hormone analogue therapy did not change vascular indices (21 women), while fibroid volume decreased.…”

“…Three‐dimensional (3D) power Doppler (PD) imaging is frequently used to assess the vascularity of a volume/organ. 3D PD is reported as a reproducible technique in the assessment of fibroids and it has been used to measure vascularisation after gonadotrophin‐releasing hormone analogues and ulipristal acetate therapy . It has not yet been studied in relation to fibroid growth.…”

Rationale and design of ASTEROID 2, a randomized, placebo- and active comparator-controlled study to assess the efficacy and safety of vilaprisan in patients with uterine fibroids

“…Progesterone receptor modulators (PRMs) act directly on progesterone receptors in the smooth muscle of UFs, resulting in inhibition of cell proliferation and stimulation of apoptosis [7,8]. In women with UFs, treatment with PRMs such as mifepristone, asoprisnil and ulipristal acetate (UPA) has been shown to induce amenorrhoea [9][10][11][12][13]; furthermore, UPA has been shown to reduce UF size to a similar extent as uterine artery embolization [14]. UPA (5 mg daily) is approved in the European Union for the intermittent treatment of moderate to severe symptoms of UFs in adult women of reproductive age [15].…”

Cystic degeneration of uterine leiomyoma during ulipristal acetate treatment

“…This effect is related, at least in part, to both the down-regulation of the angiogenic factors VEGF and ADM and their receptors, as well as to TGF-b and EGF and their receptors [14] . Additionally, a significant reduction in fibroid vascularization has been recently described by means of 3D power Doppler ultrasound after 3 months of UPA treatment [22] . Moreover, a moderate reduction in uterine artery blood flow was also reported following treatment with SPRMs [14] .…”