Ultrasonographic appearance of the endometrium after saline infusion in women presenting with PRM-associated endometrial changes, due to the use of ulipristal acetate

Abstract

Ulipristal acetate (UPA), used for the treatment in women with symptomatic fibroids, is associated with endometrial changes visualised on ultrasound as thickening up to more than 16 mm in approximately 10% of the patients. Is saline infusion sonography (SIS) a good alternative for more invasive techniques, to evaluate the presence of intrauterine pathology? Ten patients, presenting with UPA associated endometrial changes at their follow up ultra-sonographic evaluation, were included. Our study demonstrated that SIS is feasible and painless in patients presenting with UPA associated endometrial changes. The thickened endometrium appears to divide at the midline, making it possible to study both layers separately and exclude any suspected intrauterine pathology. Our findings suggest that SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive.

Impact Statement

• What is already known on this subject? Reversible endometrial changes after ulipristal acetate (UPA) treatment in patients with symptomatic fibroids have been described. In patients who receive UPA, especially if planned to undergo ART, assessment of potential endometrial pathology is important as such interfere with proper implantation after ART. Consequently, clinicians may consider ruling out intrauterine pathology by invasive examinations such as biopsy or hysteroscopy after visualisation of the thickened endometrium.

• What do the results of this study add? Saline infusion sonography (SIS) was feasible and painless in patients presenting with UPA associated endometrial changes.

• What are the implications of these findings for clinical practice and/or further research? SIS may be a first choice, non-invasive, painless technique to provide a proper visualisation to rule out intrauterine pathology when UPA associated endometrial changes are diagnosed after fibroid treatment. This is especially of clinical interest in front of assisted reproductive technology treatment. Invasive techniques can be withheld for patients in whom SIS examination is not contributive in excluding intrauterine pathology.

Keywords:

• Saline infusion sonography
• ulipristal acetate
• fibroid
• endometrial changes
• gynaecological ultrasound and imaging

Ethics statement

Hospital ethical approval (Research Ethics Committee of the University Hospital Universitair Ziekenhuis Brussel, Brussels, Belgium) was received and before performing the saline instillation, a written informed consent was obtained from the patient. Reference number from IRB: B.U.N. 143201524322.

Author contributions

Cosyns S.: conception and design of the study, acquisition and analysis of data and writing of the manuscript with review and final approval.

Dony N.: acquisition and interpretation of data, critically revising manuscript and final approval.

Tournaye H.: design of the study, critically revising manuscript and final approval.

Polyzos N.P.: design of the study, interpretation of data, critically revising manuscript and final approval.

Disclosure statement

The corresponding author declares to have received honoraria as member of an advisory board organised by the commercial producer of ulipristal acetate. The other authors have no conflicts of interest to declare.