title: Role of ethnicity in treating uterine fibroids with ulipristal acetate.
abstract: OBJECTIVE
  To study differences in treatment effect between black and white premenopausal women prescribed ulipristal acetate (UPA) for symptomatic uterine fibroids.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Gynecology clinics.
  
  
  METHODS
  Premenopausal women aged 18-55 years, at least one symptomatic uterine fibroid, UPA-naïve, and no contraindications for UPA treatment.
  
  
  METHODS
  One 3-month course of UPA at 5 mg daily.
  
  
  METHODS
  Patients' ethnicity self-identification adapted from Statistics Canada National Household Survey. Change in fibroid symptoms according to Uterine Fibroid Symptoms Quality of Life Questionnaire symptom severity and health-related quality of life score. Bleeding symptoms and amenorrhea rates according to Aberdeen Bleeding Score.
  
  
  RESULTS
  A total of 148 patients enrolled (45 black, 59 white, 44 other ethnicity). Black patients were younger (40.3 y vs. 44.5 y) with larger uteri (523 mL vs. 351 mL) than white counterparts. Baseline symptom severity was similar between groups. After 3 months of UPA treatment, both groups experienced similar improvements in symptom severity. White women had 52% greater improvement in bleeding score (-40.3 vs. -26.5) and were more likely to be amenorrheic at the end of treatment (66% vs. 41%). Both groups experienced adverse events at similar frequencies. Black women were more dissatisfied with UPA compared with white women (27.3% vs. 8%).
  
  
  CONCLUSIONS
  Black women had greater fibroid burden at baseline. Both ethnicities had similar improvement in fibroid symptomatology following UPA treatment, but white women experienced higher amenorrhea rates. Black women were more dissatisfied with UPA treatment, which may be related to the lower amenorrhea rates.
authors.affiliation: Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada. Electronic address: amurji@mtsinai.on.ca.
authors.forename: Ally
authors.initials: A
authors.lastname: Murji
authors.affiliation: University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Crosier
authors.affiliation: University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Chow
authors.affiliation: Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Xiang Y
authors.initials: XY
authors.lastname: Ye
authors.affiliation: Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Shirreff
mesh_terms: D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced / Q000208:ethnology; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D044383:Black People; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007889:Leiomyoma / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D008875:Middle Aged; D009649:Norpregnadienes / Q000009:adverse effects / Q000627:therapeutic use*; D009864:Ontario / Q000453:epidemiology; D017060:Patient Satisfaction / Q000208:ethnology; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D044465:White People; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D009649:Norpregnadienes; C555622:ulipristal acetate
keywords: Uterine leiomyoma; ethnicity; medical therapy; ulipristal acetate