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Ulipristal Acetate Prior to Surgery for Endometriosis

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Abstract

Selective progesterone receptor modulators may have a role in the treatment of endometriosis. The aim of this report is to review the effect of ulipristal acetate (UPA) on endometriosis lesions and symptoms in women treated prior to surgery. A pathology review of eutopic endometrium and endometriotic lesions was conducted by two gynecologic pathologists. The main outcome measures reported are pain reduction, amenorrhea, and pathologic progesterone receptor modulator-associated endometrial changes (PAECs). Overall, fifteen women with endometriosis received UPA over a 27-month study period. UPA was administered in an intermittent fashion in the majority of patients while 27% of patients had continuous treatment, between 6 and 24 months. Eleven (73%) patients reported amenorrhea on UPA and 11 (92%) of 12 patients with pain reported pain reduction or resolution. Fourteen patients (93%) proceeded with surgical management. Thirteen (93%) patients underwent excision of suspected endometriosis at surgery. Twelve cases (86%) had concurrent eutopic endometrium specimens and PAEC was identified in 58% (n = 7). Among the 14 cases that underwent surgery, a total of 49 extraovarian sites were sampled. Endometriosis was definitively identified in 31 (63%) of these sites. Three cases (21%) showed morphologic features similar to PAEC within foci of endometriosis. All cases of PAEC-like features in endometriosis also had PAEC in the endometrium. These patients had all noted pain reduction and amenorrhea preoperatively. In conclusion, PAECs may be found in endometriosis lesions in patients treated with UPA. Further prospective investigation is required to evaluate the efficacy and safety of SPRMs in women with endometriosis.

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Acknowledgments

The authors would like to thank The Ottawa Hospital Minimally Invasive Gynecology Group staff for helping facilitate the completion of this project (Ms. Suzannah Wojcik BHScH, Dr. Teresa Flaxman PhD, and Ms. Erica Nichols RN).

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Newborn Care, Shirley E. Greenberg Women’s Health Centre, Riverside Campus, The Ottawa Hospital, University of Ottawa & Ottawa Hospital Research Institute, 1967 Riverside Drive, 7th Floor, Ottawa, Ontario, K1H 7W9, Canada

    Sukhbir S. Singh & Shannen McDonald

  2. Department of Obstetrics, Gynecology and Reproductive Sciences Rady Faculty of Health Sciences, University of Manitoba, RS432 – 810 Sherbrook St, Winnipeg, Manitoba, R3A 1R8, Canada

    Devon Evans

  3. Department of Pathology and Laboratory Medicine, Division of Anatomical Pathology, University of Ottawa, 451 Smyth Road, RGN: Room 4155, Ottawa, Ontario, K1H 8M5, Canada

    Mary Senterman & Sarah Strickland

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  1. Sukhbir S. Singh
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  2. Devon Evans
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  4. Mary Senterman
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  5. Sarah Strickland
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Contributions

Dr. S. Singh developed the concept for this work and all authors contributed to data acquisition, interpretation, manuscript development, and final review.

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Correspondence to Sukhbir S. Singh.

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Conflict of Interest

S.S.S. reports other from Allergan, other from AbbVie, other from Bayer, personal fees from Allergan, personal fees from AbbVie, personal fees from Bayer, personal fees from Hologic, and personal fees from Cooper Surgical, outside the submitted work.

D.E. has no conflicts of interest.

S.M. has no conflicts of interest.

M.S. has no conflicts of interest.

S. S. has no conflicts of interest.

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Singh, S.S., Evans, D., McDonald, S. et al. Ulipristal Acetate Prior to Surgery for Endometriosis. Reprod. Sci. 27, 1707–1714 (2020). https://doi.org/10.1007/s43032-020-00146-1

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  • DOI: https://doi.org/10.1007/s43032-020-00146-1

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