Ulipristal acetate therapy increases ultrasound features of adenomyosis: a good treatment given in an erroneous diagnosis of uterine fibroids

Abstract

Ulipristal acetate (UPA) is used for medical treatment of uterine fibroids. The aim of this study was to describe the effects on painful symptoms and the sonographic uterine modifications in patients with adenomyosis erroneously treated with UPA. This is an observational study on six women affected by adenomyosis and treated with three months of UPA (5 mg/24h). The baseline ultrasonography (US) was not performed at out center nor was the diagnosis of fibroids. The patients came to our attention after the treatment with UPA, prescribed by an external physician. During our post-treatment scan we found aspects of adenomyosis, while no fibroids were detected. Symptoms, myometrial and endometrial ultrasound features were evaluated. All patients reported an increase in pelvic pain. At US evaluation intramyometrial cystic areas were found in all six cases (100%). All patients showed an enhancement of adenomyosis features.The intra-myometrial cysts appeared enlarged and the vascularization enhanced when compared to the images of the pretreatment scan. In patients with adenomyosis treated with UPA due to an erroneous diagnosis of uterine fibroids we observed a worsening of the US features of adenomyosis and of the painful symptoms.

摘要

醋酸乌利司他（Ulipristal, UPA）用于治疗子宫肌瘤。本研究的目的是描述误用了UPA治疗的子宫腺肌症及其对患者疼痛症状和子宫超声改变的影响。这是一项观察性研究, 研究对象是6名患有子宫腺肌症的女性, 她们接受了3个月的UPA（5mg/24h）治疗。基线超声检查（US）既没有在中心外进行, 也没有对肌瘤进行诊断。患者在接受外聘医生开具的UPA治疗后引起了我们的注意。在我们的治疗后扫描中, 我们发现了子宫腺肌症的各个方面的数据, 而没有检测到肌瘤。对患者症状、子宫肌瘤及子宫内膜超声特征进行评估, 所有患者主诉盆腔疼痛增加。在超声检查中, 6例患者均发现子宫肌层内囊性区域（100%）、所有患者子宫腺肌症特征增强。与治疗前扫描图像相比, 治疗后子宫肌层内囊肿增大, 血管化回声增强。在因误诊为子宫肌瘤而接受UPA治疗的子宫腺肌症患者中, 我们观察到子宫腺肌症的超声特征和疼痛症状的恶化。

Keywords:

• Endometriosis
• adenomyosis
• ultrasound
• ulipristal acetate

Disclosure statement

No potential conflict of interest was reported by the authors.