ENDOMETRIAL SAFETY OF ULIPRISTAL ACETATE TREATMENT
FOR SYMPTOMATIC UTERINE FIBROIDS IN PREMENOPAUSAL
WOMEN - A SYSTEMATIC REVIEW
LIANA PLEȘ 1,2, DELIA CARP 2, ROMINA MARINA SIMA 1,2*, ALEXANDRA MIRICĂ 1,3, ANCA-DANIELA STĂNESCU 1,2, DENISA-OANA BĂLĂLĂU 1,2, CRISTIAN BĂLĂLĂU 1,4
1“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2“Sf. Ioan” Hospital, "Bucur" Maternity, Bucharest, Romania
3“C. I. Parhon” National Institute of Endocrinology, Bucharest, Romania
4“Sf. Pantelimon” Emergency Clinical Hospital, Department of Surgery, Bucharest, Romania
*corresponding author: romina.sima@yahoo.es
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Abstract:
The aim of the present article was to evaluate endometrial safety of the ulipristal acetate (UPA) treatment for uterine
symptomatic fibroids by reviewing the relevant studies and to provide confidence in SPRM (Selective Progesterone Receptor
Modulators) clinical use. We designed a review protocol according to PRISMA guidelines and electronic databases search.
The databases searched were PubMed, Embase and Cochrane for terms "ulipristal acetate", "endometrium" and "fibroid" or
synonyms. After screening, 41 full-text studies were retained, with 9 included selected: 7 randomized controlled, one
prospective observational case control and one off label including 1997 patients treated with UPA. Dosage, interval and
endometrial aspects at biopsy were described. UPA-induced non-physiological histological changes of the endometrium were
reported by 5 studies. The overall quality of the studies was good. No premalignant or malignant endometrial changes were
reported. Evidences provided by the study are consistent - UPA can be prescribed for conservative or pre-surgical treatment
of fibroids without concern on possible endometrial malignancies.

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