P14.07: Thickened endometrium secondary to continuous ulipristal acetate treatment

A 37 year-old nulliparous woman was referred to our centre due to hypermenorrhea and uterine leiomyomatosis. She had had two previous laparotomic multiple myomectomies in other centres. She was complaining from heavy menses as well as pelvic pain. At ultrasound examination, she had multiple intramural myomas as well as four submucous myomas of less than two centimetres. The rest of the myometrium appeared as adenomiotic (myometrial heterogenicity, ecogenic linear striation, infiltration of Junctional Zone). After trying treatment with progesterone with no symptomatic control, ulipristal acetate was prescribed. The patient took the treatment continuously for ten months (at her choice without medical agreement). The ultrasound examination at this point showed up a thickened heterogeneous endometrium (34 mm). A hysteroscopic exam was then decided, and revealed a thickened with increased vessels endometrium, compatible with PAEC (Progesterone Associated Endometrial Changes). The patient stopped the treatment and at two months follow up showed a normal echographic, hysteroscopic and histologic endometrial pattern. Since the patient wanted to preserve uterus, a hysteroscopic resection of the submucous myomas was decided. During the surgery, four myomas were resected completely and adenomyosis was confirmed.