title: Uterine leiomyoma: available medical treatments and new possible therapeutic options.
abstract: BACKGROUND
  Uterine leiomyomas (fibroids or myomas) are benign tumors of the uterus and are clinically apparent in up to 25% of reproductive-age women. Heavy or abnormal uterine bleeding, pelvic pain or pressure, infertility, and recurrent pregnancy loss are generally associated with leiomyoma. Although surgical and radiological therapies are frequently used for the management of this tumor, medical therapies are considered the first-line treatment of leiomyoma.
  
  
  METHODS
  A review was conducted of electronic and print data comprising both original and review articles on pathophysiology and medical treatments of uterine leiomyoma retrieved from the PubMed or Google Scholar database up to June 2012. These resources were integrated with the authors' knowledge of the field.
  
  
  CONCLUSIONS
  To date, several pathogenetic factors such as genetic factors, epigenetic factors, estrogens, progesterone, growth factors, cytokines, chemokines, and extracellular matrix components have been implicated in leiomyoma development and growth. On the basis of current hypotheses, several medical therapies have been investigated. GnRH agonist has been approved by US Food and Drug Administration for reducing fibroid volume and related symptoms. In addition, the FDA also approved an intrauterine device, levonorgestrel-releasing intrauterine system (Mirena), for additional use to treat heavy menstrual bleeding in intrauterine device users only. Currently, mifepristone, asoprisnil, ulipristal acetate, and epigallocatechin gallate have been shown to be effective for fibroid regression and symptomatic improvement which are all in clinical trial. In addition, some synthetic and natural compounds as well as growth factor inhibitors are now under laboratory investigation, and they could serve as future therapeutic options.
authors: Department of Experimental and Clinical Medicine, Faculty of Medicine, Polytechnic University of Marche, via Tronto 10/a, 60020 Ancona, Italy.
authors: Md Soriful
authors: MS
authors: Islam
authors: Olga
authors: O
authors: Protic
authors: Stefano Raffaele
authors: SR
authors: Giannubilo
authors: Paolo
authors: P
authors: Toti
authors: Andrea Luigi
authors: AL
authors: Tranquilli
authors: Felice
authors: F
authors: Petraglia
authors: Mario
authors: M
authors: Castellucci
authors: Pasquapina
authors: P
authors: Ciarmela
mesh_terms: D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy* / Q000601:surgery; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000601:surgery
chemical_list: D003271:Contraceptive Agents, Female; D004791:Enzyme Inhibitors; D006727:Hormone Antagonists; D006728:Hormones