Ulipristal acetate for the treatment of fibroids

This is an update to the 2007 NICE guideline on managing heavy menstrual bleeding. It advises that ulipristal acetate can be used in the treatment of fibroids. Specifically:

  • Offer ulipristal acetate 5mg for up to 4 courses to a woman with heavy menstrual bleeding, fibroids of 3cm or more in diameter and Hb of 102g/L or less.
  • Consider ulipristal acetate for the same women with Hb of more than 102g/L.

Ulipristal acetate is used in higher doses as emergency contraception (Ella-One). It is a progesterone receptor modulator.

In this case the dose is lower. It is given as a 'course' for 3m, then 2m off. This can be repeated 4 times.

There is some concern over whether there is an increased risk of endometrial hyperplasia, so the SPC advises that when menstruation resumes after treatment, 'periodic monitoring' of the endometrium is recommended. This should include an annual ultrasound.

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