OP30.04: Changes in the sonographic characteristics of adenomyosis after treatment with ulipristal acetate

To investigate the changes in the sonographically detectable alterations of the myometrium caused by adenomyosis in patients treated with ulipristal acetate (UPA) because of uterine fibroids. This prospective study included women of reproductive age with adenomyosis and uterine fibroids. Exclusion criteria for the study were: previous uterine surgery and uterine malformations. Patients were offered a 3-month treatment with oral UPA (5 mg/day) prior to laparoscopic or hysteroscopic treatment of uterine fibroids. Ultrasonography was performed before starting the treatment and at the completion of the therapy by a physician blinded to the use of hormonal treatment. The pictorial blood-loss assessment chart (PBAC) was used to estimate uterine bleeding. 16 women were enrolled in the study. 5 patients interrupted the treatment because of the increased severity of pain; their mean (± SD) length of treatment was 29.8 (±19.1) days. At the end of the 3-month treatment (n = 11), 6 patients had PBAC 28-day score < 2 and 5 patients had PBAC 28-days score < 75; 54.5% of these patients reported a worsening of pain symptoms. The mean (± SD) maximal junctional zone thickness significantly increased at the completion of treatment (17.2 ± 2.8 mm) compared with baseline (15.5 ± 2.5 mm; p = 0.015). The treatment increased the number of subendometrial linear striations (p = 0.003), the size of anechoic areas (p = 0.012) and the size of myometrial cysts (p = 0.036) but it did not change the number of anechoic areas (p = 0.895) and of myometrial cysts (p = 0.751). The treatment significantly decreased the volume of fibroids (p = 0.031; percentage reduction, mean ± SD: 34.3% ± 10.2%). In patients with adenomyosis and uterine fibroids, UPA causes an improvement of the bleeding but it may worsen pain symptoms. This observation is justified by the worsening of several ultrasonographic characteristics of adenomyosis.