title: Hysteroscopic Patterns in Women on Treatment With Ulipristal Acetate 5 mg/day: A Preliminary Study.
abstract: To describe the hysteroscopic findings in women on treatment with ulipristal acetate (UPA) and to define the most common hysteroscopic patterns related to the treatment and compare them with the histologic findings.
  
  
  
  Preliminary study.
  
  
  
  OB-GYN and Gynecology Oncology Clinic, Military Medical Institute, Ministry of Defense, Warsaw, Poland, and Obstetrics and Gynecology Department, University of Bari, Italy.
  
  
  
  Seventy-four premenopausal patients complaining of abnormal uterine bleeding due to uterine myomas and on treatment with UPA 5 mg/day for at least 30 days.
  
  
  
  Women received transvaginal sonography (TVS) and then office hysteroscopy and visually guided endometrial biopsies. Video hysteroscopies were recorded in digital format. Pictures were evaluated by 2 authors off-line and compared with histologic results.
  
  
  
  Hysteroscopic aspects and classification of progesterone receptor modulator-associated endometrial changes were measured. The most common hysteroscopic finding was the combination of a flat subtle epithelium with small glandular openings; large isolated or confluent cysts in the stroma, giving the surface a floating aspect at fluid distention; and well-evident subendometrial vascular network with a "chicken-wire" vascular pattern (44.6%). This finding accounted for 82% of cases with endometrial thickness > 10 mm at TVS. Histology confirmed a combination of epithelial secretory (vacuoles) and hypotrophic effects (small and dilated glands), whereas at stromal level the combination of cysts, dense stroma, and vascular wall thickening was found. At 3 months follow-up echographic, hysteroscopic, and histologic endometrial patterns were normal in all patients.
  
  
  
  In most women on UPA and with thickened endometrium at TVS, the hysteroscopy showed benign and characteristics aspects related to the ambivalent effects of UPA on progesterone receptor. These alterations took place just after 1 month of treatment but disappeared within 3 months of stopping treatment.
authors.affiliation: Department of Obstetrics and Gynecology, D.I.M.O. Department, University of Bari "Aldo Moro", Baro, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bettocchi
authors.affiliation: OB-GYN and Gynecology Oncology Clinic, Military Medical Institute, Ministry of Defense, Warsaw, Poland.
authors.forename: Wlodzimierz E
authors.initials: WE
authors.lastname: Baranowski
authors.affiliation: OB-GYN and Gynecology Oncology Clinic, Military Medical Institute, Ministry of Defense, Warsaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Doniec
authors.affiliation: Department of Obstetrics and Gynecology, D.I.M.O. Department, University of Bari "Aldo Moro", Baro, Italy.
authors.forename: Oronzo
authors.initials: O
authors.lastname: Ceci
authors.affiliation: Department of Pathology, University Hospital Policlinico of Bari and University of Bari "Aldo Moro", Baro, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Resta
authors.affiliation: Department of Obstetrics and Gynecology, D.I.M.O. Department, University of Bari "Aldo Moro", Baro, Italy.
authors.forename: Fabiana Divina
authors.initials: FD
authors.lastname: Fascilla
authors.affiliation: Department of Obstetrics and Gynecology, D.I.M.O. Department, University of Bari "Aldo Moro", Baro, Italy.
authors.forename: Paola Carmela
authors.initials: PC
authors.lastname: Mitola
authors.affiliation: Department of Obstetrics and Gynecology, "San Bassiano" Hospital, Bassano del Grappa, Vicenza, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Tinelli
authors.affiliation: Department of Obstetrics and Gynecology, D.I.M.O. Department, University of Bari "Aldo Moro", Baro, Italy. Electronic address: ettore.cicinelli@uniba.it.
authors.forename: Ettore
authors.initials: E
authors.lastname: Cicinelli
mesh_terms: D000328:Adult; D001706:Biopsy / Q000379:methods; D003270:Contraceptive Agents / Q000008:administration & dosage / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D004717:Endometrium / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007558:Italy; D007889:Leiomyoma / Q000209:etiology / Q000473:pathology; D009649:Norpregnadienes / Q000008:administration & dosage / Q000009:adverse effects; D010865:Pilot Projects; D011044:Poland; D011980:Receptors, Progesterone / Q000037:antagonists & inhibitors; D013997:Time Factors; D014463:Ultrasonography / Q000379:methods; D014592:Uterine Hemorrhage / Q000175:diagnosis / Q000209:etiology; D014594:Uterine Neoplasms / Q000209:etiology / Q000473:pathology
chemical_list: D003270:Contraceptive Agents; D009649:Norpregnadienes; D011980:Receptors, Progesterone; C555622:ulipristal acetate
keywords: Endometrium; Histology; Hysteroscopic patterns; Hysteroscopy; Progesterone receptor modulators; Ulipristal; Ultrasounds