Hysteroscopic Patterns in Women on Treatment With Ulipristal Acetate 5 mg/day: A Preliminary Study

详细信息    查看全文

• 作者：Stefano Bettocchi ; MD^a ; Wlodzimierz E. Baranowski ; MD^b ; Jacek Doniec ; MD^b ; Oronzo Ceci ; MD^a ; Leonardo Resta ; MD^c ; Fabiana Divina Fascilla ; MD^a ; Paola Carmela Mitola ; MD^a ; Raffaele Tinelli ; MD^d ; Ettore Cicinelli ; MD^a ; ^{ettore.cicinelli@uniba.it" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Endometrium ; Histology ; Hysteroscopic patterns ; Hysteroscopy ; Progesterone receptor modulators ; Ulipristal ; Ultrasounds
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：July-August 2016
• 年：2016
• 卷：23
• 期：5
• 页码：664-669
• 全文大小：834 K

文摘

To describe the hysteroscopic findings in women on treatment with ulipristal acetate (UPA) and to define the most common hysteroscopic patterns related to the treatment and compare them with the histologic findings.

Design

Preliminary study.

Setting

OB-GYN and Gynecology Oncology Clinic, Military Medical Institute, Ministry of Defense, Warsaw, Poland, and Obstetrics and Gynecology Department, University of Bari, Italy.

Patients

Seventy-four premenopausal patients complaining of abnormal uterine bleeding due to uterine myomas and on treatment with UPA 5 mg/day for at least 30 days.

Interventions

Women received transvaginal sonography (TVS) and then office hysteroscopy and visually guided endometrial biopsies. Video hysteroscopies were recorded in digital format. Pictures were evaluated by 2 authors off-line and compared with histologic results.

Measurements and Main Results

Hysteroscopic aspects and classification of progesterone receptor modulator–associated endometrial changes were measured. The most common hysteroscopic finding was the combination of a flat subtle epithelium with small glandular openings; large isolated or confluent cysts in the stroma, giving the surface a floating aspect at fluid distention; and well-evident subendometrial vascular network with a “chicken-wire” vascular pattern (44.6%). This finding accounted for 82% of cases with endometrial thickness > 10 mm at TVS. Histology confirmed a combination of epithelial secretory (vacuoles) and hypotrophic effects (small and dilated glands), whereas at stromal level the combination of cysts, dense stroma, and vascular wall thickening was found. At 3 months follow-up echographic, hysteroscopic, and histologic endometrial patterns were normal in all patients.

Conclusions

In most women on UPA and with thickened endometrium at TVS, the hysteroscopy showed benign and characteristics aspects related to the ambivalent effects of UPA on progesterone receptor. These alterations took place just after 1 month of treatment but disappeared within 3 months of stopping treatment.