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Jahanfar S, Mortazavi J, Lapidow A, Cu C, Al Abosy J, Ciana H, Morris K, Steinfeldt M, Maurer O, Bohang J, Anjali Oberoi R, Ali M. Assessing the impact of hormonal contraceptive use on menstrual health among women of reproductive age - a systematic review. EUR J CONTRACEP REPR 2024:1-31. [PMID: 39007750 DOI: 10.1080/13625187.2024.2373143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/21/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Contraceptive methods are well-established in their ability to prevent pregnancy and increase individual agency in childbearing. Evidence suggests that contraceptives can also be used to treat adverse conditions associated with menstruation, including abnormal and prolonged uterine bleeding, heavy menstrual bleeding, painful menstruation, endometriosis, uterine fibroids, and premenstrual dysphoric disorders.This review investigates the effects of contraceptive techniques such as contraceptive pills, and long-acting reversible contraceptives (e.g. intrauterine devices, implants) on menstrual morbidity. METHODS Over ten databases with no geographical boundaries were searched from inception until October 2023. Study designs were one of the following types to be included: parallel or cluster randomised controlled trials, controlled clinical trials, controlled before and after studies, interrupted time series studies, cohort or longitudinal analyses, regression discontinuity designs, and case-control studies. Ten team members screened the papers in pairs with a Kappa score of more than 7, and Covidence was used. Conflicts were resolved by discussion, and the full papers were divided among the reviewers to extract the data from eligible studies. RESULTS Hormonal contraceptives are considered a well-tolerated, non-invasive, and clinically effective treatment for abnormal and prolonged uterine bleeding, heavy menstrual bleeding, painful menstruation, endometriosis, uterine fibroids, and premenstrual dysphoric disorders. Our studies investigating quality of life or well-being in women with heavy menstrual bleeding, endometriosis, or uterine fibroids have found improvements in all dimensions assessed. CONCLUSIONS Hormonal contraceptives significantly reduce pain, symptom severity, and abnormal bleeding patterns associated with women who suffer from heavy menstrual bleeding, endometriosis, and uterine fibroids.
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Affiliation(s)
- Shayesteh Jahanfar
- Affiliate of Cochrane, US, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Julie Mortazavi
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Amy Lapidow
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Cassandra Cu
- School of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Jude Al Abosy
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Hartman Ciana
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Katherine Morris
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Meredith Steinfeldt
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Olivia Maurer
- School of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Jiang Bohang
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | | | - Moazzam Ali
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Singh S, Kumar P, Rathore SS, Singh Y, Garg N. Contemporary approaches in the management of uterine leiomyomas. Eur J Obstet Gynecol Reprod Biol 2023; 287:195-210. [PMID: 37385088 DOI: 10.1016/j.ejogrb.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/24/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Leiomyomas (fibroids), the most common benign solid tumours in females, originate from the myometrium and are associated with poor quality of life for patients. The current management of uterine leiomyomas mainly includes surgical interventions such as hysterectomy and myomectomy, either by laparoscopy or laparotomy, which have several complications and are not ideal for preserving fertility. Therefore, there is a need to develop or repurpose medical treatments that do not require surgical intervention. OBJECTIVE Many drugs are used to treat the symptoms associated with uterine fibroids. The main objective of this systematic review is to give an up-to-date account of potential pharmacological agents (non-surgical methods) for the management of uterine leiomyomas. SEARCH STRATEGY PubMed was searched for scientific and clinical literature using the keyword 'uterine fibroids' along with the drug names described in each section. For example, 'uterine fibroids' and 'ulipristal acetate' were the keywords used to search for literature on ulipristal acetate (UPA). RESULTS Various preclinical and clinical studies have shown that some drugs and herbal formulations exhibit activity in the management of uterine leiomyomas. Recent studies found that drugs such as UPA, elagolix, EC313, asoprisnol, nutritional supplements and herbal preparations were helpful in treating the symptoms associated with uterine leiomyomas. CONCLUSION Many drugs show efficacy in patients with symptomatic uterine fibroids. UPA is one of the most studied and prescribed medicines for uterine fibroids; however, its usage has been restricted due to a few recent incidences of hepatic toxicity. Herbal drugs and natural supplements have also shown promising effects on uterine fibroids. The synergistic effects of nutritional and herbal supplements have been reported in certain cases, and should be studied in detail. Further research is warranted to identify the mode of action of the drugs, and to determine the precise conditions that would explain the causes of toxicity in some patients.
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Affiliation(s)
- Shikha Singh
- Department of Prasuti Tantra, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Praveen Kumar
- Department of Medicinal Chemistry, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Saurabh Singh Rathore
- Department of Biotechnology, Mahatma Gandhi Central University, Raghunathpur, Motihari, East Champaran, Bihar, India
| | - Yashasvi Singh
- Department of Urology, CSSB, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Neha Garg
- Department of Medicinal Chemistry, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
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Abstract
PURPOSE OF REVIEW This review is intended to provide perspective on the history of selective progesterone receptor modulators (SPRMs) and progesterone antagonists, their current availability, therapeutic promise and safety concerns. RECENT FINDINGS Despite keen interest in synthesis of these compounds, only a handful have had clinical test results allowing for commercialization. Mifepristone is well tolerated and effective for single dose first trimester at-home pregnancy termination and is available in much of the world. Ulipristal acetate, at single doses, is well tolerated and effective for emergency contraception, with less availability. Chronic use of these agents has been associated with abnormal liver enzymes, and rarely, with hepatic failure; causality is not understood. SUMMARY SPRMs and progesterone antagonists have great therapeutic promise for use in other reproductive disorders, including breast cancer, endometriosis, adenomyosis, estrogen-free contraception and cervical ripening but require additional study. Alternative formulations, whether local (topical breast or intrauterine) or extended-release may reduce the incidence of liver function abnormalities and should be explored.
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Jha S, Ahmed N, Sinha HH. Safety and efficacy of two repeated cycles of ulipristal acetate in the management of symptomatic uterine fibroid among Indian women. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:127-132. [PMID: 34703413 PMCID: PMC8525252 DOI: 10.5114/pm.2021.109509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION To evaluate the safety and efficacy along with the impact on uterine and fibroid vascular indices of 2 repeat 12-week courses of ulipristal acetate (UPA) among Indian women. MATERIAL AND METHODS Ninety-four premenopausal women aged 18-45 years with at least 1 symptomatic fibroid of size ranging from 1 cm to 10 cm were included in the study. All participants received 2 courses of 5 mg of UPA orally for 12 weeks starting from the 5th day of their menstrual cycle with a 2-menstrual-cycle break in between. The efficacy was measured in terms of time to amenorrhoea, percentage of women who achieved amenorrhoea for the last 35 consecutive days, reduction in uterine and fibroid volume, as well as its vascularity at the end of the first and second treatment cycle. RESULTS Eighty-six women completed the first treatment cycle whereas only 65 women completed the second treatment course. Seventy-nine per cent of women achieved amenorrhoea for 35 consecutive days during the first treatment cycle. Median time to amenorrhoea was 7 days and 5 days during the first and second treatment cycle, respectively. Percentage reduction of the mean fibroid volume was 32% and 52% after the first and second treatment cycle, respectively. We observed an increase in fibroid vascular indices (pulsatility index and resistive index) suggesting reduction in fibroid vascularity. Serum oestradiol remained at mid-follicular phase. No serious drug emergent side effect was noted. CONCLUSIONS Two interrupted repeat course of 5mg UPA is well tolerated efficient and safe in symptomatic fibroid among Indian women.
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Affiliation(s)
- Sangam Jha
- All India Institute of Medical Sciences, Patna, India
| | - Naaz Ahmed
- All India Institute of Medical Sciences, Patna, India
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Osuga Y, Nakano Y, Yamauchi Y, Murakawa H. Phase III long-term study to evaluate the efficacy and safety of ulipristal acetate in Japanese patients with uterine fibroids. J Obstet Gynaecol Res 2021; 47:3269-3278. [PMID: 34109697 PMCID: PMC8453825 DOI: 10.1111/jog.14802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/14/2021] [Accepted: 04/10/2021] [Indexed: 11/29/2022]
Abstract
Aim To assess the efficacy and safety of long‐term intermittent administration of 10‐mg ulipristal acetate (UPA) for symptomatic uterine fibroids in Japanese women. Methods Open‐label, noncomparative study (Japan Primary Registries Network identifier: JapicCTI‐173737) conducted at 32 gynecological centers (November 2017–December 2019). Premenopausal women diagnosed with uterine fibroids associated with heavy menstrual bleeding received three 12‐week courses of 10‐mg UPA once daily. Amenorrhea, fibroid volume, endometrial histology, and safety were assessed. Results Of 155 patients enrolled, 140 received ≥1 dose of UPA and were analyzed. Across all courses, the rates of patients with amenorrhea for 35 days were >90%, and >99% of patients achieved uterine bleeding normalization. Median time to amenorrhea after each course started was 4–5 days; menstruation returned after treatment within a median of 25–27 days. Mean changes in fibroid volume from baseline were −21.5%, −31.4%, and −35.0% for Courses 1, 2, and 3, respectively. Patients experienced sustained improvements in anemia, pain, and quality of life during treatment. Most adverse events were mild/moderate in severity and decreased in frequency with each course. Seven serious adverse events (six patients) were reported; anemia, embolic cerebral infarction, and pituitary apoplexy (one patient each) were considered UPA‐related. Nonphysiological changes in endometrial histology were transient and benign. No safety concerns were detected in hormone concentrations or liver function tests. Conclusions Long‐term administration of 10‐mg UPA is effective for reducing symptoms associated with uterine fibroids in Japanese women. UPA was well tolerated and few safety concerns were reported.
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Affiliation(s)
- Yutaka Osuga
- Department of Gynecologic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasuaki Nakano
- Clinical Development Department, ASKA Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Yuji Yamauchi
- Clinical Development Department, ASKA Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Hitoshi Murakawa
- Clinical Development Department, ASKA Pharmaceutical Co., Ltd., Tokyo, Japan
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Kounidas G, Kastora SL, Barnott E, Black L, Robinson-Burke T, Gould A, Morgan D, Urquhart G, Poobalan A, Jack A. Efficacy of ulipristal acetate in women with fibroid induced menorrhagia: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2021; 50:102173. [PMID: 34082168 DOI: 10.1016/j.jogoh.2021.102173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the efficacy of UPA in women with fibroid induced menorrhagia. METHODS Embase, MEDLINE, CAB Abstracts, Cochrane Central Register of Controlled Trials, PsychInfo were searched up to 18th May 2020 and updated on 7th February 2021. Randomised controlled trials evaluating the efficacy of UPA in women with fibroid induced menorrhagia were included in the study. RESULTS Two authors independently reviewed and extracted the study data. Statistical heterogeneity was quantified using I2 statistics. Publication bias and data asymmetry was assessed by funnel plots. A meta-analysis was conducted where appropriate. Six studies were eligible for inclusion. UPA (5 mg and 10 mg) achieved statistically significant amenorrhoeic outcome when compared to placebo (p<0.00001). Increased adverse events (AE) profile was observed in the higher UPA dose, however, did not reach statistical significance. CONCLUSIONS This review demonstrates the efficacy of UPA in achieving amenorrhoea in women with fibroid induced menorrhagia. However, the favourable dose of UPA remains inconclusive when AE profile is taken into account. Evidence remains obscure regarding liver damage and further research is warranted to attain a conclusive outcome.
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Affiliation(s)
- Georgios Kounidas
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD.
| | - Stavroula Lila Kastora
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Emma Barnott
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Lydia Black
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Tamara Robinson-Burke
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Alexandra Gould
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Dale Morgan
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Grace Urquhart
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Amudha Poobalan
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
| | - Alison Jack
- University of Aberdeen, School of Medicine, Medical Sciences and Nutrition, Aberdeen, United Kingdom, AB25 2ZD
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Yoon EL, Yuk JS. Use of Ulipristal Acetate and Risk of Liver Disease: A Nationwide Cohort Study. J Clin Endocrinol Metab 2021; 106:1773-1782. [PMID: 33567071 DOI: 10.1210/clinem/dgab081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Large-scale clinical trials on the hepatotoxicity of ulipristal acetate (UPA) are lacking. OBJECTIVE This work aimed to determine the incidence of liver disease with UPA vs gonadotropin-releasing hormone (GnRH) agonists. METHODS A retrospective cohort study was conducted in South Korea of women with uterine fibroids from the Korean Health Insurance Data 2010 to 2018. Women with uterine fibroids were divided into 2 treatment groups: the UPA (5 mg/day) and GnRH agonist groups. Main outcome measures included the presence or absence of severe liver disease, mild liver disease, and liver transplantation. RESULTS Among the patients with uterine fibroids,17 207 patients were treated with GnRH agonists and 20 926 patients with UPA. After 1:1 propensity score matching for each group, there were 11 445 individuals. Neither group had a liver transplantation case. In the conditional logistic regression analysis, the incidence of total liver diseases (relative risk [RR] 1.111; 95% CI, 1.015-1.216) and mild liver diseases (RR 1.094; 95% CI, 1-1.196) was higher in the UPA group than in the GnRH agonist group, but that of severe liver diseases (RR 0.07; 95% CI, 0.001-4.412) and toxic liver disease (RR 1.256; 95% CI, 0.845-1.867) did not differ between the groups. CONCLUSION The incidence of severe liver disease, hepatic failure, and toxic liver disease was not different between the UPA and GnRH agonist groups. However, the incidence of mild liver disease was higher in the UPA group than in the GnRH agonist group. The incidence of hepatic damage with UPA was very low.
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Affiliation(s)
- Eileen L Yoon
- Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Jin-Sung Yuk
- Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Nowon-gu, Seoul 01757, Republic of Korea
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Osuga Y, Nakano Y, Yamauchi Y, Takanashi M. Ulipristal acetate compared with leuprorelin acetate for Japanese women with symptomatic uterine fibroids: a phase III randomized controlled trial. Fertil Steril 2021; 116:189-197. [PMID: 33715871 DOI: 10.1016/j.fertnstert.2021.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of ulipristal acetate (UPA) for uterine fibroids (UFs), a phase III study was conducted with leuprorelin (LEU) as a comparator. This is the first confirmatory trial of UPA for UFs among Asians. DESIGN Multicenter, randomized, double-blind, double-dummy, parallel-group study. SETTING Thirty-two sites in Japan. PATIENT(S) Patients were assigned to 2 arms, with 82 patients in the UPA group and 79 patients in the LEU group. INTERVENTION(S) In the UPA group, 10 mg of UPA was orally administered once a day for 12 weeks. In the LEU group, 1.88 mg or 3.75 mg of LEU was subcutaneously administered at weeks 0, 4, and 8. MAIN OUTCOME MEASURE(S) The primary endpoint was the percentage of patients with amenorrhea for 35 days. For safety evaluation, adverse events (AEs) were recorded. RESULT(S) The percentage of patients with amenorrhea for 35 days was 87.0% in the UPA group and 81.8% in the LEU group, and the efficacy of UPA for causing amenorrhea for 35 days was confirmed to be noninferior to that of LEU. AEs occurred in 78.0% of the patients in the UPA group and 88.8% of the patients in the LEU group. CONCLUSION(S) The effect of UPA on heavy menstrual bleeding was shown to be comparable with that of LEU in Japanese patients with symptomatic UFs. No notable AEs occurred because of the UPA treatment, and the incidence of AEs in the UPA group was comparable with that of AEs in the LEU group. This result demonstrates the clinical utility of UPA for Asians.
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Affiliation(s)
- Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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