Treatment using Ulipristal Acetate medication is an effective alternative for uterine fibroids that do not require surgery, or for patients who are unable to undergo surgery due to health issues.
Currently, a medication known as ESMYA® (trade name) is available as a 5-mg tablet with the generic name Ulipristal Acetate. It is a drug in the Selective Progesterone Receptor Modulator (SPRM) class of medications with predominantly inhibitory effects on the progesterone receptor, exerting direct action on three parts, as follows:
- Uterine Fibroids: The medication causes the size of the fibroids to be reduced by inhibiting cell proliferation and inducing apoptosis.
- Pituitary Gland: The medication inhibits ovulation due to lower levels of progesterone and FSH; however, estrogen levels are maintained in the mid-follicular range in majority of patients.
- Endometrium: The drug exerts a direct effect on the endometrium. This means that, for most patients, their menstrual cycle will stop until after treatment is stopped. When the Ulipristal Acetate treatment is stopped, menstrual cycles generally resume within 4 weeks.
Esmya has been approved for 2 main therapeutic indications:
1) Treatment of uterine fibroids prior to surgery
2) Used as a course of treatment for uterine fibroids in patients who are not eligible for surgery
The drug can stop the majority of heavy menstrual bleeding within the first week of treatment and is also able to control over 90% of abnormal blood flow. It can also reduce the size of the uterine fibroids and maintain reduced fibroid size after treatment is completed. The medication also helps to reduce pain and other various symptoms. The side effects are negligible, the most common being headaches and hot flashes, unlike other used medications such as GnRH agonists, which may lead to loss of bone mineral density and other postmenopausal symptoms from estrogen deficiency.
Treatment is carried out as a 12-week course. The first treatment course should start during the first week of menstruation. There should be a break of 2 menstrual cycles between the first course and the second retreatment course. Retreatment courses should start at the earliest time during the first week of the second menstruation following completion of the previous treatment course.