Selective progesterone receptor modulators: an update.
BACKGROUND
Several selective progesterone receptor modulators (SPRMs) show promise in several areas of medicine and this work has been summarized by us in 2008.


METHODS
Since the publication of our reviews, several developments have taken place in the field of reproductive medicine. The first is emergency contraception (EC). Two SPRMs are clinically utilized today: mifepristone (MFP) and ulipristal acetate (UPA). MFP is available for EC in up to 120 h following unprotected intercourse. A dose of 10 mg is significantly more effective than levonorgestrel (LNG). In a metanalysis of the use of UPA versus LNG up to 72 h after unprotected intercourse, failure rates of 1.4 versus 2.2% were reported. The second is contraception. A daily dose of 2 mg MFP can block ovulation and several MFP regimens are being tested, including a vaginal ring releasing MFP. The third is the preoperative administration in women harboring leiomyomas, where clinical testing of several SPRM has shown that they can decrease uterine leiomyomas' size and substantially reduce uterine bleeding. SPRM can induce unusual, specific endometrial appearances. Many believe that these changes should not cause concern, but the issue remains controversial.


CONCLUSIONS
SPRMs are very effective in EC and for the preoperative treatment of uterine leiomyomas.
University of Rome, 'Sapienza', Department of Gynaecology, Obstetrics and Urology , C/O AIED Via Toscana 30, 00187 Rome , Italy Manuela.farris@uniroma1.it.
Giuseppe
G
Benagiano
Carlo
C
Bastianelli
Manuela
M
Farris
Ivo
I
Brosens
D062788:Adenomyosis / Q000188:drug therapy; D000818:Animals; D002986:Clinical Trials as Topic; D044363:Contraception, Postcoital / Q000379:methods; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D003281:Contraceptives, Postcoital / Q000627:therapeutic use; D004715:Endometriosis / Q000188:drug therapy; D004963:Estrenes / Q000627:therapeutic use; D005260:Female; D006727:Hormone Antagonists / Q000627:therapeutic use; D006801:Humans; D007889:Leiomyoma / Q000188:drug therapy; D016912:Levonorgestrel / Q000627:therapeutic use; D015735:Mifepristone / Q000627:therapeutic use; D009649:Norpregnadienes / Q000627:therapeutic use; D010091:Oximes / Q000627:therapeutic use; D011980:Receptors, Progesterone / Q000378:metabolism*; D014594:Uterine Neoplasms / Q000188:drug therapy
D003271:Contraceptive Agents, Female; D003281:Contraceptives, Postcoital; D004963:Estrenes; D006727:Hormone Antagonists; D009649:Norpregnadienes; D010091:Oximes; D011980:Receptors, Progesterone; D015735:Mifepristone; D016912:Levonorgestrel; C488516:asoprisnil; C555622:ulipristal acetate
adenomyosis; asoprisnil; contraception; emergency contraception; endometriosis; mifepristone; proellex; selective progesterone receptor modulators; ulipristal acetate; uterine leiomyomas