Author(s): Bhatia K., Mohammad H.Y., Nethra S.
Abstract: Ulipristal is an orally active tissue-specific progesterone receptor (PR) modulator with established efficacy in emergency contraception and pre-operative management of fibroids. It modulates PR activity without suppressing estradiol to postmenopausal levels and hence has advantage over GnRH analogues with fewer side effects when used for pre-operative shrinkage of fibroids. A single 12 week course has been shown to reduce fibroid volume by 40% with shrinkage maintained for up to 6 months. Recent publications confirm efficacy and safety with longer term repeated courses and promising role as the only medical treatment of fibroid related symptoms without resorting to invasive therapy With increasing longer term use of Ulipristal (Esmya 5mg / day) as a novel medical treatment for fibroid symptoms, it is important to report any unreported side effects, although its overall safety profile so far has been good. We would like to report an unusual complication of sudden rebound increase in size of submucous fibroid (increase from 2cm to 10cm) on discontinuation of treatment with unusual cystic degeneration, mistaken for a failing triplet pregnancy on the ultrasound. This clearly resulted in a management dilemma. To the best of our knowledge this has not been reported before. We believe it is important to increase awareness of this fibroid treatment complication with misleading ultrasound images, especially in those with submucous fibroids. Hysteroscopic resection should be offered in favour of medical treatment in women with resectable submucous fibroids.
Publication Type: Journal: Conference Abstract