scholarly journals Mechanisms involved in the contraceptive effects of ulipristal acetate

Reproduction ◽  
2020 ◽  
Vol 159 (3) ◽  
pp. R139-R149
Author(s):  
María José Munuce ◽  
Matías D Gómez-Elías ◽  
Adriana M Caille ◽  
Luis Bahamondes ◽  
Patricia S Cuasnicú ◽  
...  
Keyword(s):  
Ovarian Function ◽  
Unplanned Pregnancy ◽  
Hormonal Treatment ◽  
First Line ◽  
Unprotected Sexual Intercourse ◽  
Principal Mechanism ◽  
Ulipristal Acetate ◽  
Receptor Modulator ◽  
Contraceptive Effectiveness ◽  
The Moment

The use of emergency contraception (EC) methods is increasing worldwide as it constitutes an effective way to prevent unplanned pregnancy after unprotected sexual intercourse. During the last decade, ulipristal acetate (UPA), a selective progesterone receptor modulator, has emerged as the most effective EC pill, and it is now recommended as first-line hormonal treatment for EC in several countries. Its principal mechanism of action involves inhibition or delay of follicular rupture, but only when administered during the follicular phase before the luteinizing hormone (LH) peak. However, considering the high efficacy of UPA, it is possible that it also exerts contraceptive effects besides ovulation. In the present review, we summarize and discuss the existing evidence obtained on the effect of UPA on sperm function and post-ovulatory events as potential additional mechanisms to prevent pregnancy. The bulk of evidence collected so far indicates that UPA would not affect gamete function; however, it could impair embryo–uterine interaction. Thus, besides the described effects on ovarian function, UPA contraceptive effectiveness might also be attributed to post-ovulatory effects, depending on the moment of the female cycle in which the drug is administered.

scholarly journals Effect of a Selective Progesterone Receptor Modulator on Induction of Apoptosis in Uterine Fibroids In Vivo

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Petr Horak ◽  
Michal Mara ◽  
Pavel Dundr ◽  
Kristyna Kubinova ◽  
David Kuzel ◽  
...  
Keyword(s):  
Uterine Fibroids ◽  
Premenopausal Women ◽  
Hormonal Treatment ◽  
Control Groups ◽  
Ulipristal Acetate ◽  
Receptor Modulator ◽  
Positive Clinical Effect ◽  
The Mean ◽  
And Control

Aim. To determine if hormonal treatment induces apoptosis in uterine fibroids.Methods. Immunohistochemical examination of fibroid tissue, using avidin-biotin complex and cleaved caspase-3 antibody for detecting apoptosis, was performed in premenopausal women who underwent 12-week treatment with oral SPRM (6 patients with 5 mg and 5 patients with 10 mg of ulipristal acetate per day) or gonadoliberin agonist (GnRHa, 17 patients) and subsequent myomectomy or hysterectomy for symptomatic uterine fibroids. Ten patients with no presurgical hormonal treatment were used as controls.Results. Apoptosis was present in a significantly higher proportion of patients treated with ulipristal acetate compared to GnRHa (P=0.01) and to patients with no hormonal treatment (P=0.01). In contrast to an AI of 158.9 in SPRM patients, the mean AI was 27.5 and 2.0 in GnRHa and control groups, respectively. No statistical difference in the AI was observed between the two groups of patients treated with ulipristal acetate (5 mg or 10 mg).Conclusion. Treatment with ulipristal acetate induces apoptosis in uterine fibroid cells. This effect of SPRM may contribute to their positive clinical effect on uterine fibroids.

scholarly journals Knowledge and attitude towards emergency contraception in females of urban area of Lucknow, Uttar Pradesh, India

2016 ◽  
Vol 6 (1) ◽  
pp. 210 ◽  
Author(s):  
Malvika Mishra ◽  
Shiv Shanker Tripathi ◽  
Manish Kumar Verma
Keyword(s):  
Health Education ◽  
Emergency Contraception ◽  
Unplanned Pregnancy ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Health Awareness ◽  
Cross Sectional ◽  
Negative Attitudes ◽  
Unprotected Sexual Intercourse ◽  
Knowledge And Attitude

Background: Emergency contraception are birth control measures that, if taken after unprotected sexual intercourse, contraceptive failure, incorrect use of contraceptives or in cases of sexual assault may prevent pregnancy. The aim of the study was to assess the knowledge and attitude of female living in urban part of Lucknow district from September 2015 to August 2016.Methods: This was a descriptive, cross-sectional study conducted at RML Hospital, Lucknow from September 2015 to August 2016. A cross sectional study design was conducted and Participants were selected using simple random sampling method. Data was collected by using self-administered questionnaires. Data processing and analysis: The collected data was entered into a computer and analyzed using statistical package of social science version 20.0.Results: In this study it was found that, Out of 385 subjects 54% (209) new the correct time interval for EC to be effective and 91% (350) new that this is for prevention of unplanned pregnancy. Out of 385 subjects 77% (345) reported that they had heard the word EC from different sources, however 23% (90) reported that they never heard about that it means that still there is a scope of health awareness activities and health education to improve the knowledge of EC. Different attitudes of females towards emergency contraception some different pair of questions was asked. Out of 385 subjects 85% (329) were reported that they have positive attitudes in terms of benefits of EC to reduce the risk of unplanned pregnancy. A few number of subjects i.e. 12% (48) reported negative attitudes towards EC where as 3 % (8) did not respond. The more than half subjects i.e. 68% (260) reported that they use EC even if their partners disagreed with them where as 11% (41). Cultural belief was found as an barrier in having negative attitudes towards EC. The Religion, Occupation and educational status affect knowledge and attitudes towards EC.Conclusions: The results show that there is a scope of health awareness activities and health education to improve the knowledge and attitude towards EC.

scholarly journals Predictive Factors of Response to Selective Progesterone Receptor Modulator (Ulipristal Acetate) in the Pharmacological Treatment of Uterine Fibroids

2020 ◽  
Vol 17 (3) ◽  
pp. 798
Author(s):  
Iwona Szydłowska ◽  
Aleksandra Marciniak ◽  
Jolanta Nawrocka-Rutkowska ◽  
Aleksandra Rył ◽  
Andrzej Starczewski
Keyword(s):  
Blood Flow ◽  
Progesterone Receptor ◽  
Predictive Factors ◽  
Uterine Fibroids ◽  
Volume Number ◽  
Ulipristal Acetate ◽  
Uterine Arteries ◽  
Receptor Modulator ◽  
Estradiol Concentration ◽  
Status Of Women

Background: Selective progesterone receptor modulator ulipristal acetate (UPA) is a drug used in management of symptomatic myomas. It was observed that the response to UPA treatment in uterine myomas varied amongst patients. An attempt was thus made at establishing predictive factors conducive to better reaction to treatment with UPA. The aim of this study was to assess the efficacy of UPA treatment in women with myomas, depending on pretreatment myomas’ volume, number of myomas, age of patients, estrogenic status of women, and pretreatment blood flow in uterine arteries. Materials and methods: The study included patients with one to four myomas. The UPA treatment was a preparation stage for surgical treatment in all patients. The study group was divided into the subgroups according to pretreatment myomas’ volume, number of myomas, age of patients, estrogenic status of women, and pretreatment blood flow in uterine arteries. Results: A better effect of reduction in size of myomas after UPA treatment was noted when pretreatment myomas’ volume was lower than 30 cm3. A significant reduction in fibroids’ size was observed after UPA therapy independently of the number of myomas and age of patients. A good response after the UPA therapy was observed when pretreatment estradiol concentration was below 50 pg/mL and when uterine artery resistance index (RI) was above 0.8. Conclusions: Our research demonstrates that treatment with ulipristal acetate is an efficient method in preoperative preparation of patients with uterine fibroids. The most important factor of positive response to UPA therapy is myoma volume. The number of myomas and patient’s age do not interfere with effects of UPA therapy. Pretreatment estradiol concentration is significant, yet secondary for the effects of therapy. The UPA therapy has no impact on blood flow in the uterine arteries and no adverse influence on estradiol concentrations.

scholarly journals A review of adjuvant hormonal therapy in breast cancer

2004 ◽  
Vol 11 (3) ◽  
pp. 391-406 ◽  
Author(s):  
Kellie L Jones ◽  
Aman U Buzdar
Keyword(s):  
Breast Cancer ◽  
Hormonal Therapy ◽  
Ovarian Function ◽  
Critical Role ◽  
Current Data ◽  
Adjuvant Hormonal Therapy ◽  
Breast Cancer Patients ◽  
Ovarian Suppression ◽  
Receptor Modulator ◽  
Estrogen Production

Breast cancer is the most common carcinoma diagnosed in women today excluding non-melanoma skin cancers. It has been well documented that estrogen plays a critical role in its development and is a major target for treatment. For many years, tamoxifen has been the gold standard for adjuvant hormonal therapy in breast cancer patients. With newer products targeting different mechanisms to suppress estrogen production, patients now have many decisions regarding their care. Agents such as luteinizing hormone releasing hormone (LHRH) agonists can suppress ovarian function in premenopausal patients and have been shown to be as effective and even better than chemotherapy (CMF — cyclophosphamide, methotrexate, fluorouracil-containing regimens) in certain patient populations. Tamoxifen continues to be an option as well as toremifene, a similar selective estrogen receptor modulator. With the advent of newer third generation aromatase inhibitors (anastrozole, letrozole and exemestane) toxicities have been documented to be less and in some cases they are more efficacious than the standard, tamoxifen. This article reviews the current data regarding ovarian suppression, ovarian suppression plus tamoxifen, tamoxifen, toremifene, anastrozole, letrozole, and exemestane in the treatment of adjuvant hormonal-sensitive breast cancer.

Retrospective analysis of ribociclib and letrozole as first-line therapy in patients with hormone receptor (HR) positive metastatic breast cancer (MBC) within a managed access program (MAP) in Turkey.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13055-e13055
Author(s):  
Gul Basaran ◽  
Umut Demirci ◽  
Fatih Yildiz ◽  
Irfan Cicin ◽  
Burak Yasin Aktas ◽  
...  
Keyword(s):  
Ovarian Function ◽  
De Novo ◽  
Metastatic Breast ◽  
Retrospective Chart Review ◽  
Qtc Interval ◽  
First Line ◽  
Ovarian Function Suppression ◽  
First Line Therapy ◽  
Line Therapy ◽  
Her 2

e13055 Background: The combination of ribociclib with ET significantly increased progression free survival (PFS) and OS compared with ET in first line treatment of HR positive HER2 negative MBC. We aimed to evaluate the efficacy and safety of ribociclib and letrozole within Turkish MAP in order to present clinical outcome with the real-world use of ribociclib, outside of clinical trial setting. Methods: Turkish MAP enabled access to ribociclib in combination with letrozole as first-line therapy for MBC patients with HR positive and Her-2 negative tumors. Adequate bone marrow reserve, a normal QTc interval, normal renal and liver functions were required for eligibility. Patients received 600 mg ribociclib once daily for 3 wks followed by 1wk off. A retrospective chart review of patient demographics, clinical and treatment characteristics have been performed. Results: Between July and November 2017, 178 patients were included from 47 institutions in Turkey. We report the results of first 101 patients analyzed. The median age was 53 years (33–81 years) and median follow up was 16 months. Forty-six patients had de novo disease, 78% patients were postmenopausal, 22% had ovarian function suppression. Thirty-six % patients had adjuvant chemotherapy, 49% received adjuvant ET. Forty % had visceral disease. Thirty patients had grade 3 neutropenia, 3 patients had febrile neutropenia, 5 patients have grade 2-3 elevation of liver function tests. There was no QT prolongation. Dose reduction to 400 mg was required for 16 patients. Four patients discontinued ribociclib due to toxicity, 22 patients due to progression, one patient refused treatment. Twelve patients had complete remission as their best response. Median PFS was 24.12 months (95%CI 22.2-26.2). None of the clinical and pathologic factors were significantly associated with prolonged PFS. Conclusions: The efficacy and toxicity of first-line ribociclib and letrozole within Turkish MAP is similar to the results from randomized clinical studies for patients with HR positive, Her-2 negative MBC.

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