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The current Place of Medical Therapy in

Uterine Fibroid Management
Jacques Donnes, MD, PhD, Proffessor EM Director, Oliver Donnez MD, PhD, Mairie-
Madeleiine Dolmans, MD, PhD

Mentor :
dr. Khairani Sukatendel, Mked(OG), SpOG(K)

By:
Dian Riani Siregar

OBSTETRI DAN GYNAECOLOGY DEPARTEMENT
NORTH SUMATERA UNIVERSITY
ADAM MALIK GENERAL HOSPITAL
MEDAN
2018

• Most common form of benign uterine tumors • Choice of treatment : patient ABSTRACT age and desire to preserve INTRODUCTION fertility or avoid “radical” Why we need surgery new options? • Evidance Progesterone The Future of pathways in the Medical Therapy pathophysiology of uterine Conclusion fibroids and the efficacy of long term intermittent sPRMs such as ulipristil acetace (UPA) .

Conclusion • 30% cause morbidity because AUB and pelvic pressure (urinary symptoms. thus originationg from the myometrium ABSTRACT INTRODUCTION • Composed of large amounts of ECM containing collagen. increasing Medical Therapy to 70% by the age 50. fibronection and Why we need proteoglycans new options? The Future of • Occur in 50-60% women. constipation. and tenesmus) . • Monoclonal tumors of uterine smooth muscle.

Conclusion health costs estimated over $2 billion per year.000 INTRODUCTION hysterectomies Why we need performed/year in USA new options? The Future of Medical Therapy 200. . ABSTRACT • Among 600.000 are for fibroids. • Current treatments mainly surgical and expensive.

fibroid ABSTRACT • Tsigkou et al.Evidance of the crucial role of • PAST : Esterogen considered to be progesterone pathways in the major growth factor in myoma the pathopysiology of uterine development. Conclusion • Progesterone can cause rapid. membrane-initiated effects. new options? Histologically and phamacological studies. independent of gene transcription. shown progesterone and The Future of its receptors play a key role in Medical Therapy uterine fibroid growth. : PR-B mRNA and PR- INTRODUCTION A and PR-B proteins were more concentrated in leiomyomas than Why we need in matched myometrium. that alter the production of second messengers involved in cell signaling transduction pathways. .

ulipristal The Future of acetate (UPA). and telapristone acetate Medical Therapy Conclusion • Shown decrese leiomyoma size and reduce uterine bleeding in a dose- dependent manner. ABSTRACT INTRODUCTION • Four members of the family of compound SPRMs have been Why we need investigeted in phase II clinical trials: new options? mifepristone. asoprisnil. . • SPRMs : synthetic compounds that exert either an agonistic or SPRMs and fibroids antagonistic effect on PRs.

have proved to be benign Conclusion and reversible. as they disappear 2 months after the end of therapy. present in almost Medical Therapy 70% of patients at the end of treatment. . the induced effects on Why we need the endometrium.SPRMs and fibroids ABSTRACT INTRODUCTION • Importantly. now described as progesterone receptor modulator new options? (PRM) associated endometrial The Future of changes (PAECs).

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Medical Therapy Conclusion • Endometrial safety after > 4 treatment courses. ABSTRACT INTRODUCTION • Cinical trial investigate the efficacy and safety of 4 repeted 12-week courses of Why we need either 5 or 10 mg UPA daily for new options? intermittent treatment of symptomatic The Future of uterine fibroids : similar degree of response in both treatment groups.Long-term intermittent • > 1 course of SPRMs : maximize its administration of SPRMs. opening up new treatment potential benefits in terms of bleeding perspectives control and fibroid volume reduction. Hyperplasia with atypia or endometrial carcinoma . no increased occurrence of more serious condition of the endometrium ex.

Incerased apoptotic index rate The Future of 2. offering explanation for the sustained ABSTRACT benefecial effect.Long-term intermittent • Courtoy et al. INTRODUCTION • Multifactorial mechanisms of action Why we need involve : new options? 1. : important role of UPA in administration of SPRMs. ECM remodelling concomitant with Medical Therapy stimulation of MMP-2 expression Conclusion . opening up new treatment collagen degradation induced by MMP- perspectives 2.

The daily dose of 5 mg was there for chosen. No difference was observed in term of afficacy (fibroid volume reduction) between the dose of 5 mg and 10 m. Moreover it should be noted that the secound course maximize the effect of the firtst one .Uterine fibroid reduction from screening to course for and follow up.

Novel approaches and algorithms. to consider key factors determining the management of uterine fibroids. cutting the pedicle by hysteroscopy. with a special emphasis on infertility FIGO classification to address the question of which therapy to adopt. In case of more than 4 cm in size it may be appropriate to reduce the myoma size preoperatively by giving one or two courses of UPA. .  Type 0 myomas are present.  Type 1 myomas myomas less than 3 cm in size.

patients with symptomatic myomas have an enlarged uterus with multiple myomas or large myomas of type 2-5. . SPRMs exert an anti-proliferative effect in breast tissue. The goal is to reach menopause without surgery. Type 2 or type 2-5 myomas (single or multiple) distroting the uterine cavity. Majority cases. Repeated therapy may be proposed when symptoms recure. In case of a good response. treatment can be stopped after four courses and the patient is re-evaluated.

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agenda • Future clinical trials : focus on prevention strategies and avoiding recurrence after surgery in women at high risk. . • SPRMs : opened up new avenues to explore in fibroid medical therapy. to both treat symptoms and postpone or Research eliminate the need for surgery.

INTRODUCTION Why we need • SURGICAL INTERVENTION : new options? hysterectomy. myomectomy by hysterescopy. Medical Therapy CONSLUSION • The need for medical therapy remains reality. and myomectomy by The Future of laparascopy or laparatomy. particularly when fertility preservation is the goal . • SURGICAL +/ MEDICAL THERAPY ABSTRACT severity of symptoms & FIGO classification. as it is essential that new treatments be developed.

ABSTRACT • There is growing evidence of the crucial role of progesterone in INTRODUCTION pathways in the pathophysiology Why we need of uterine fibroids by using SPRMs. new options? The Future of • UPA was found that maximizes its Medical Therapy potential benefits in terms of CONCLUSION bleeding control and fibroid volume reduction more than one 3-month course. .

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