Three-month treatment with ulipristal acetate prior to laparoscopic myomectomy of large uterine myomas: a retrospective study

ObjectiveTo assess the usefulness of 3-month treatment with ulipristal acetate (UPA) before laparoscopic myomectomy of large uterine myomas.Study designThis retrospective analysis of a prospectively collected database included women of reproductive age requiring laparoscopic myomectomy with the following characteristics: FIGO type 3, 4 or 5 myomas; largest diameter of the main myoma ≥10 cm; number of myomas ≤3; largest diameters of the other myomas ≤5 cm (second myoma) and ≤3 cm (third myoma). Patients either underwent direct surgery (group S) or were treated before surgery with UPA for 3 months (group UPA).ResultsThe mean (±SD) intraoperative blood loss was lower in group UPA (507.1 ± 214.9 ml) than in group S (684.2 ± 316.8; p = 0.012). The total operative time was lower in group UPA (137.6 ± 26.8 min) than in group S (159.7 ± 26.8 min; p < 0.001); there was no significant difference in the suturing time between the two study groups (p = 0.076). Hemoglobin drop was lower in group UPA (1.1 ± 0.5 g/dl) than in group S (1.3 ± 0.7 g/dl; p = 0.034). Six patients in group S and no patient in group UPA required postoperative blood transfusions (p = 0.031). Complications were not different between the two groups (p = 0.726). Moreover, preoperative treatment with UPA caused a significant increase in hemoglobin levels (11.9 ± 1.6 g/dl) compared with baseline (9.1 ± 1.1 g/dl; p < 0.001).ConclusionA 3-month treatment with UPA before laparoscopy for large uterine myomas decreases intraoperative blood loss, hemoglobin drop, postoperative blood transfusion and length of surgery.