title: Therapeutic drugs in the treatment of symptomatic uterine fibroids.
abstract: BACKGROUND
  The therapy of symptomatic uterine fibroids is based on surgery in the majority of cases. Conservative medical treatment in cases of contraindication against operative treatment, bleeding control or preoperative down-sizing of the fibroids is classically based on sex steroid depletion by gonadotropin-releasing hormone (GnRH) agonist administration for a prolonged period. However, this approach is associated with often severe climacteric side effects and fibroids quickly relapse after treatment cessation. Furthermore, the achievement of menstrual bleeding control has been tried by administration of combined oral contraceptives, progestins or the levonorgestrel-releasing intrauterine device. These approaches, however, are not associated with a significant reduction in fibroid volume.
  
  
  METHODS
  With the introduction of Ulipristal acetate (UPA), a new selective progesterone receptor modulator (SPRM) is now licensed for the preoperative treatment of fibroids. The administration should be limited to 3 months. UPA induces amenorrhea within a relatively short term of - on average - 7 days and may thus reduce fibroid-induced anemia. Furthermore, a significant reduction of the fibroid volume persisting after cessation of the treatment could be demonstrated for UPA. Herein, a review of the current therapeutic options for conservative and preoperative medical fibroid treatment is given and the clinical utility of UPA is outlined.
  
  
  CONCLUSIONS
  In contrast to precedent myoma medication, volume reduction of the fibroids persists several months after cessation of UPA-administration. UPA optimizes operative conditions and thus the postoperative outcome by reducing anemia and down-sizing of fibroids.
authors.affiliation: University Hospital of Schleswig-Holstein, Department of Obstetrics and Gynecology , Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck , Germany +49 451 500 2140 ; +49 451 500 2196 ; friederike.hoellen@uksh.de.
authors.forename: Friederike
authors.initials: F
authors.lastname: Hoellen
authors.forename: Georg
authors.initials: G
authors.lastname: Griesinger
authors.forename: Michael K
authors.initials: MK
authors.lastname: Bohlmann
mesh_terms: D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy*; D011372:Progestins / Q000627:therapeutic use; D011966:Receptors, LHRH / Q000819:agonists; D011980:Receptors, Progesterone / Q000378:metabolism
chemical_list: D011372:Progestins; D011966:Receptors, LHRH; D011980:Receptors, Progesterone