{"paper_id":"47fefb97-1464-4611-aa5c-d720a69fcc6f","body_text":"Abstract\nThe growth of a uterine leiomyoma stops and regresses after the menopause suggesting that leiomyoma growth is dependent on ovarian steroids. Therefore, estrogen has received much attention as the major factor responsible for the development of uterine leiomyomas, but progesterone also plays an important role in development of this disease.\nCytogenetic analyses of resected samples has revealed that about 40 to 50% of leiomyomas show karyotypically detectable chromosomal abnormalities.\nGonadotrophin releasing hormone (GnRH) agonists exert their action through the suppression of endogenous gonadotrophins and gonadal steroid secretion. Significant reductions of uterine/leiomyoma volume under GnRH agonist therapy has been reported in several studies. However, the leiomyoma generally returns to its pretreatment volume within a few months after discontinuation of the GnRH agonist. To minimise the adverse effects of hypoestrogenism during GnRH agonist treatment, add back therapy can be used (estrogen-progestin, progestin alone and recently tibolone).\nAntiprogestins have a potential clinical utility in uterine leiomyomas. Mifepristone is a synthetic steroid with both antiprogesterone and antiglucocorticoid activities, that may have an inhibitory effect on growth of leiomyoma. Danazol is an isoxazole of 17β-ethinyl testosterone, a synthetic steroid, which has a suppressive effect on sex hormone binding globulin concentrations, resulting in efficacy in the short-term treatment of uterine leiomyomas. Gestrinone is a tri-enic steroid with antiestrogen and antiprogesterone properties and has been shown to reduce uterine volume and stop bleeding.\nGrowth factors play a relevant role on the pathophysiology of uterine leiomyoma and probably the inhibition of the action of growth factors on the myometrium will be the basis for future therapy. A number of agents are under investigation for treating uterine leiomyoma. Agents developed from increasing genetic knowledge of this condition could represent, in the next few years, new trends in the medical treatment of uterine leiomyomas.\nSimilar content being viewed by others\nReferences\nVollenhoven BJ, Reiter RC. Uterine leiomyomata: etiology, symptomatology and management. Fertil Steril 1981; 36: 433–45\nCramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94: 435–8\nVollenhoven BJ, Lawrence AS, Healy DL. Uterine fibroids: a clinical review. Br J Obstet Gynaecol 1990; 97: 285–98\nParazzini F, La Vecchia C, Negri E, et al. Epidemiologic characteristic of women with uterine fibroids: a case control study. Obstet Gynecol 1988 72: 853–7\nCantuaria GHC, Angioli R, Frost L, et al. Comparison of bi-manual examination with ultrasound examination before hysterectomy for uterine leiomyomas. Obstet Gynecol 1998 92: 109–12\nBrown AB, Chamberlain R, Te Linde RW. 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Interferon-alpha is a potent inhibitor of basic fibroblast growth factor-stimulated cell proliferation in human uterine cells. Am J Reprod Immunol 1998 40: 19–25\nAcknowledgements\nThe authors thank Dr L. Pasqui, Dr B. Talluri and Mrs D. Ceccarelli for their assistance in the preparation of the manuscript.\nNo sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.\nAuthor information\nAuthors and Affiliations\nRights and permissions\nAbout this article\nCite this article\nDe Leo, V., Morgante, G., La Marca, A. et al. A Benefit-Risk Assessment of Medical Treatment for Uterine Leiomyomas. Drug-Safety 25, 759–779 (2002). https://doi.org/10.2165/00002018-200225110-00002\nPublished:\nIssue date:\nDOI: https://doi.org/10.2165/00002018-200225110-00002","source_license":"CC0","license_restricted":false}