Treatment of uterine fibroid: focus on endometrial receptivity. A pilot randomized prospective study

Background. Uterine fibroid (UF) is one of the most relevant conditions in modern gynecology, adversely impacting the quality of life of patients with a symptomatic course. In addition, it can be a risk factor for reduced fertility or even infertility, significantly limiting reproductive potential. The impact of a benign tumor on the endometrium state is currently being actively discussed, which may become another potential target in UF therapy. Aim. To evaluate the effect of hormonal therapy of symptomatic UF on the endometrium morphological and functional features and receptivity in patients of reproductive age. Materials and methods. A pilot randomized prospective study was conducted, which included 45 patients of reproductive age with UF sized less than 12 obstetric weeks, mostly intramural localization (types 3–6 according to the International Federation of Gynecology and Obstetrics). Group 1 (n=24) included patients with UF who were treated with a selective progesterone receptor modulator, mifepristone 50 mg per day, and group 2 (n=21) – with gonadotropin-releasing hormone agonist triptorelin acetate 3.75 mg once every 28 days for 3 months. The samples from all patients were subjected to immunohistochemical examination before the start of drug therapy and at the first menstruation after the end of treatment. Results. After 3 months of therapy, a more prominent improvement in the endometrium receptor status was noted in the mifepristone group due to a decrease in the ratio of progesterone to estrogen [2.21±0.47 vs 3.34 (1.42; 5.83) in group 1 and 2.35±0.35 vs 3.78 (3.11; 5.05) in group 2] and normalization of the level of leukemia inhibitory factor (mean value 9.4±3.51 vs 6.95±1.76). Conclusion. A personalized approach to UF drug therapy is pathogenetically justified and helps to alleviate UF symptoms and improve patients' quality of life. Selective progesterone receptor modulators increase fertility, improve the receptivity and morphological and functional features of the endometrium, and reduce the need for surgeries, which is especially important in patients of reproductive age.