Endometrial dating sternberg
Since UPA does not alter basal levels of luteinizing hormone and follicle stimulating hormone, estradiol levels remain within the physiological mid-follicular range (60–150 pg/m L) and hence the symptoms of estrogen deprivation do not occur.However, UPA induces amenorrhea in most women due to its interaction with endometrial progesterone receptors.19,20 In conclusion, UPA selectively acts on uterine fibroids and their related symptoms and represents a promising new option for the pre-surgical medical treatment of uterine fibroids.In addition to that, no randomized controlled trial has proven that the benefits of danazol outweigh its risks, when treating uterine fibroids.7 The use of a levonorgestrel intrauterine device (LNG-IUS) has been associated with a reduction in menstrual blood loss in women with uterine myomas, but its effect on the size of uterine myoma is still debated.8 LNG-IUS is contraindicated in the case of fibroid-associated severe distortion of the uterine cavity (LNG-IUS Sm PC), because of the high expulsion rate.8–10Furthermore, gonadotropin-releasing hormone analogs (Gn RHa) proved to be successful both as a conservative treatment and as a preoperative therapy of myomas.They are highly effective in reducing both the symptoms (bleeding, anemia, and abdominal pain) and the volume of fibroids.11,12 However, these effects are transient and the myomas usually return to pre-therapy size within a few months of discontinuation.
Furthermore, some of the treatment-associated adverse effects (menopausal symptoms, osteoporosis, and pelvic pain) could benefit from a hormonal add-back although it may reduce the beneficial effects of Gn RHa on myoma size.13Recently, the potential therapeutic role of non-steroidal aromatase inhibitors has been suggested.14 Aromatase inhibitors appear as effective as Gn RHa, and have fewer side effects.
However, the use of these drugs is presently restricted to infertile women due to the unknown influence of body mass index on treatment efficacy, the sparse data on subsequent reproductive outcome, and the absence of long-term follow-up data.15In uterine fibroids estrogen and progesterone receptors are expressed at higher levels than in normal myometrium.16 The influence of estrogen on fibroid growth is well-known, while the role of progesterone and the progesterone-receptor (PR), as well as ovarian steroids has emerged only recently.
In fact, biochemical and clinical studies have suggested that the former may enhance proliferative activity in fibroids and the latter may influence fibroid growth.17 These observations have inspired studies testing the efficacy of anti-progestins in the medical management of uterine fibroids.
Correspondence: Roberto Marci, Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Infertility Unit, University of Ferrara, Corso Giovecca 183, 44121, Ferrara, Italy, Email [email protected] The full terms of the License are available at
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