Treatment of Endometriosis-Related Chronic Pelvic Pain with Ulipristal Acetate and Associated Endometrial Changes

Leah Hawkins Bressler, Lia A Bernardi, Mallory A Snyder, Jian-Jun Wei, Serdar Bulun
HSOA journal of reproductive medicine gynaecology & obstetrics · 2017 · vol. 2 , pp. 1–3 · doi:10.24966/rmgo-2574/100008 · PMID:30680372 · PMC6342495 · W2810133773
article OA: gold CC0 ⤵ 11 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Ulipristal acetate treatment substantially reduced pelvic pain in a patient with endometriosis, inducing amenorrhea and characteristic endometrial changes that resolved after drug discontinuation.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This single-patient case report evaluated the effects of ulipristal acetate, a selective progesterone receptor modulator, on treatment-refractory endometriosis-related chronic pelvic pain in a 25-year-old nulligravida with symptoms persisted despite surgery and continuous oral contraceptives. The patient received 15 mg ulipristal every other day for 12 weeks with daily pain and bleeding tracking, serial serum chemistries/hormones, and pre-treatment plus surveillance endometrial biopsies assessed by histology and estrogen/progesterone receptor immunohistochemistry. Pain decreased significantly to a median score of 0 with development of amenorrhea, while surveillance biopsy during month 3 showed progesterone receptor modulator–associated endometrial changes that mimicked simple hyperplasia but resolved after ulipristal discontinuation and withdrawal bleed; immunostaining showed estrogen and progesterone receptors present before and during therapy. The paper’s major limitation is that it is only a single case with a nonstandard, U.S.-adapted dosing regimen and a treatment duration capped at 12 weeks due to safety data constraints. This paper is centrally about endometriosis — specifically, using ulipristal acetate to treat endometriosis-related chronic pelvic pain and describing associated endometrial changes.

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Abstract

BACKGROUND: Aberrant progesterone signaling has been demonstrated in mechanistic studies to be a shared common pathway in fibroids and endometriosis. Progesterone receptor modulation with the selective progesterone receptor modulator (SPRM) ulipristal may decrease pain associated with endometriosis. CASE: A 25-year-old nulligravidae with endometriosis-related pelvic pain refractory to medical and surgical intervention was administered 15mg ulipristal every other day for 3 months. Daily pain scores and bleeding diary were recorded and serum chemistries and hormone levels were checked prior to, during, and after treatment. Pre-treatment and surveillance endometrial biopsy specimens were examined for histology and stained for estrogen and progesterone receptor status. During therapy, pain scores decreased to a median of 0 (P<0.05) and the patient became amenorrheic. Surveillance endometrial biopsy demonstrated SPRM-associated endometrial changes that appeared strikingly similar to simple hyperplasia and resolved with ulipristal discontinuation. Immunohistochemical evaluation demonstrated the presence of estrogen and progesterone receptors before and during ulipristal treatment. CONCLUSIONS: Progesterone receptor modulation with ulipristal substantially improved pain symptoms in a patient with treatment-refractory endometriosis. SPRM-associated changes in the endometrium closely mimicked hyperplasia, developed after less than three months of treatment, and resolved after discontinuation of ulipristal and induction of withdrawal bleed.

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Condition tags

endometriosischronic_pelvic_pain

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