Endometrial changes during ulipristal acetate use: A systematic review

Area of Science:

• Gynecology
• Pharmacology
• Pathology

Background:

• Ulipristal acetate is used for emergency contraception and uterine fibroids.
• Its progesterone antagonist effect may lead to unopposed estrogen and potential endometrial changes.
• Concerns exist regarding the risk of endometrial malignancies with ulipristal acetate use.

Purpose of the Study:

• To systematically review literature on histopathological and imaging characteristics of endometrial changes associated with ulipristal acetate.
• To evaluate the reversibility of these changes after treatment cessation.
• To assess the risk of (pre-)malignant endometrial lesions in ulipristal acetate users.

Main Methods:

• Systematic literature search in Embase, Cochrane Library, and PubMed following PRISMA guidelines.
• Inclusion of all full-text studies reporting endometrial changes in ulipristal acetate users.
• Quality assessment of included studies and analysis of histopathological and imaging data.

Main Results:

• Progesterone receptor modulator associated endometrial changes (PAEC) were observed in 41-78.8% of patients during treatment.
• PAEC were found to be reversible after discontinuing ulipristal acetate.
• Endometrial hyperplasia (0.4%) and one case of adenocarcinoma (pre-existing) were reported; no non-reversible malignant lesions were identified in short-term follow-up.

Conclusions:

• Ulipristal acetate-associated endometrial changes (PAEC) are common but reversible.
• Short-term use of ulipristal acetate does not appear to be associated with irreversible endometrial pathologies.
• Further research is needed to confirm the safety of long-term or intermittent ulipristal acetate use.