Uterine Fibroids: Literature Review and Summary of Posters

Benagiano, Giuseppe

doi:10.1159/000181326

Cited by 11 publications

(3 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This report was followed by a large number of trials and gave rise to great hope that a medical treatment of uterine myomas had been finally found and that medical therapy would avoid surgery altogether, at least in older women. Unfortunately, the specific features of this approach, as shown in Figure 1, indicate that, whereas GnRHSA do shrink most fibroids considerably, myoma’s regrowth and recurrence of symptoms invariably follows discontinuation of treatment 37–39. Not only the effect seems to vanish after discontinuing therapy, the use of the analog cannot be prolonged beyond 6 months, because of the untoward consequences of the hypoestrogenism caused by the GnRHA, first and foremost an increased risk of osteoporosis that cannot be counteracted by calcitonin 40…”

Section: Medical Treatmentmentioning

confidence: 99%

<p>Uterine fibroids: an update on current and emerging medical treatment options</p>

Farris

Bastianelli

Rosato

et al. 2019

TCRM

View full text Add to dashboard Cite

Uterine fibroids are the most common gynecological disorder, classically requiring surgery when symptomatic. Although attempts at finding a nonsurgical cure date back to centuries, it is only around the middle of the last century that serious attempts at a medical treatment were carried out. Initially, both progestins and estrogen–progestin combinations have been utilized, although proof of their usefulness is lacking. A major step forward was achieved when peptide analogs of the GnRH were introduced, first those with superagonist properties and subsequently those acting as antagonists. Initially, the latter produced side effects preventing their routine utilization; eventually, this problem was overcome following the synthesis of cetrorelix. Because both types of analogs produce hypoestrogenism, their use is limited to a maximum of 6 months and, for this reason, today they are utilized as an adjuvant treatment before surgery with overall good results. Over the last decade, new, nonpeptidic, orally active GnRH-receptor blockers have also been synthesized. One of them, Elagolix, is in the early stages of testing in women with fibroids. Another fundamental development has been the utilization of the so-called selective progesterone receptor modulators, sometimes referred to as “antiprogestins”. The first such compound to be applied to the long-term treatment of fibroids was Mifepristone; today, this compound is mostly used outside of Western Countries, where the substance of choice is Ulipristal acetate. Large clinical trials have proven the effectiveness of Ulipristal in the long-term medical therapy of fibroids, although some caution must be exercised because of the rare occurrence of liver complications. All selective progesterone receptor modulators produce unique endometrial changes that are today considered benign, reversible, and without negative consequences. In conclusion, long-term medical treatment of fibroids seems possible today, especially in premenopausal women.

show abstract

Section: Medical Treatmentmentioning

confidence: 99%

<p>Uterine fibroids: an update on current and emerging medical treatment options</p>

Farris

Bastianelli

Rosato

et al. 2019

TCRM

View full text Add to dashboard Cite

show abstract

“…Another line of evidence implicating estrogen in leiomyoma enlargement is that induction of a hypoestrogenic state such as menopause is associated with shrinkage of tumor volume. 38,39 It should be noted that menopause also results in a loss of progesterone production. Additionally, in women who are treated with gonadotropin-releasing hormone agonist (GnRH-a) to suppress the production of ovarian steroid hormones (drug-induced menopause), tumor volumes reduce to about 50% pretreatment size within several months.…”

Section: Contribution Of Progesterone and Estrogen To Leiomyoma Pathomentioning

confidence: 99%

Growth Factors and Cytokines in Uterine Leiomyomas

Andersen

1996

Semin Reprod Med

View full text Add to dashboard Cite

Uterine leiomyomas, hard masses of smooth muscle-like tissue embedded in the myometrium, may be the most common tumors among humans. These tumors enlarge in as many as 30% of women over 30 years of age, cause significant morbidity, and are the most frequent indication for hysterectomy. Many researchers and clinicians have recently directed their attentions to understanding the etiology of these benign tumors, the conditions which cause their enlargement, and appropriate therapies which may be used as alternatives to hysterectomy. The ovarian steroid hormones estrogen and progesterone are known to play a central role in the pathology of leiomyomas. Both estrogen and progesterone contribute to the pathology of leiomyomas through gene regulation, but in opposing ways. During the follicular phase, estrogen maintains high expression of several genes which are normally expressed in the differentiated myometrium of pregnancy. During the luteal phase, progesterone can increase the mitotic activity of leiomyomas, particularly in younger women. Progesterone may act by inducing the production of growth factors and/or their respective receptors. This article surveys growth factors which may promote enlargement of susceptible leiomyomas. A potential role for cytokines in leiomyoma pathology is also discussed.

show abstract

“…The successful introduction of GnRH‐analogue therapy raised the hope that surgery could be avoided altogether in many older women harbouring uterine fibroids. Unfortunately, it is well documented today that, once the effect of the agonist is reverted, the volume of both the tumour and the uterus rapidly returns to pretreatment size 31 . Long‐term follow‐up has also shown recurrence of symptoms in the majority of patients 32,33 .…”

Section: Management Of Women Who Have Completed Their Reproductive Cyclementioning

confidence: 99%

Fibroids: overview of current and future treatment options

Benagiano

Morini

Primiero

1992

BJOG

Self Cite

View full text Add to dashboard Cite

Uterine Fibroids: Literature Review and Summary of Posters

Abstract: Chronic administration of LHRH analogues produces a significant reduction in the size of uterine leiomyomata. In addition to a literature review, a summary of presentations made during the International Symposium on Endocrine Therapy is given.

Cited by 11 publications

References 3 publications

<p>Uterine fibroids: an update on current and emerging medical treatment options</p>

<p>Uterine fibroids: an update on current and emerging medical treatment options</p>

Growth Factors and Cytokines in Uterine Leiomyomas

Fibroids: overview of current and future treatment options

Contact Info

Product

Resources

About