As many as three fourths of premeno...

As many as three fourths of premenopausal women may have uterine leiomyomata (fibroids). Surgical removal of fibroids accounts for about undivided third of all hysterectomies in the United States (i.e., about 170000 procedures) Because leiomyomata contain progesterone receptors, the competitive progesterone receptor-binder mifepristone could cause leiomyomata to shrink. Eisinger and colleagues studied sum of two units dosages of mifepristone in the treatment of leiomyomata.

They recruited 40 healthy, premenopausal women who met criteria for surgical removal of uterine leiomyomata, who had uterine whirls of at least 300 mL forward ultrasonography, and who agreed to use nonhormonal contraception. Women who were trying to become pregnant were exclud as were women with gynecologic, medical, or significant psychologic symptoms, and women with elevated plains of follicle-stimulating hormone (FSH), indicating declining ovarian function. After baseline screening, participants were randomly assigned to treatment with 5 or 10 mg of mifepristone daily for six month Uterine book was assessed every two month according to ultrasonography, and blood levels of hemoglobin, liver enzyme and FSH were monitored. Endometrial biopsy was performed in succession all participants after six month The women maintained log of symptoms and menstrual spring using scoring scales to quantify symptom severity and station of blood loss.

The treatment arranges were similar in age, educational status, obstetric history, uterine contortion body mass index, and plains of hemoglobin and FSH. pair women treated with 5 mg of mifepristone did not ended the study. Mean uterine book decreased significantly in both clusters although there was no significant difference between the assemblages After two months, 17 of the 20 women (85 percent) taking 5 mg of mifepristone were amenorrheic, however by the end of six month barely 11 of the 18 women still listed in the study (61 percent) were amenorrheic. In the form into groups treated with 10 mg of mifepristone, 85 percent were amenorrheic after three month and 65 percent were amenorrheic by dint of six months.

In the one and the other groups, women reported significant declines in pelvic squeezing symptoms. Women in both form into groupss reported an increase in passionate flushes. The increase was significant in women taking 10 mg of mifepristone, where the number rose from common (5 percent) to 11 (55 percent) In the 5-mg treatment form into groups the number of women reporting heated flushes rose from seven (35 percent) to nine (45 percent) The prevalence of headache, vein swings, nausea, and fatigue decreased in as well-as; not only-but also; not only-but; not alone-but groups. Endometrial samples were obtained from 36 patients during the close attention No atypical hyperplasia was institute but simple endometrial hyperplasia was discovered in 28 percent of the women with no significant difference between treatment groups

The authors deduce that mifepristone therapy results in regression of leiomyomata with improvement in symptoms. This therapy may provide an alternative to hysterectomy or myomectomy, particularly in younger women who wish to retain fertility. The therapy also may suffer perimenopausal women manage symptoms until menopause, when fibroids regres In addition, mifepristone may provide preoperative reduction of lesions comparable to that of the GnRH analogs at lower splendor and with fewer side efficiencys and greater patient acceptability.

Eisinger SH et al. Low-dose mifepristone for uterine leiomyomata. Obstet Gynecol February 2003;101:243-50

COPYRIGHT 2003 American Academy of Family Physicians

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