Low dose mifepristone shows promise in the medical management of uterine fibroids. It has proapoptotic and antiproliferative effects that decrease fibroid size and volume. Studies show mifepristone reduces menstrual bleeding and induces amenorrhea in 90-95% of patients when used for 3-6 months, with mild side effects. Its safety has been established by international references. Mifepristone may be a reasonable alternative or adjunct to surgery for uterine fibroids.

1. Low Dose Mifeprostone
in the Management of Fibroid
…Caring hearts, healing hands
DR. SHARDA JAIN
DR JYOTI AGARWAL
A Promising* drug

2. • Great Teacher & surgeon ,taught for 2 decades in medical college (PGI Chandigarh , LHMC, Delhi )
• ETHICAL COMMITTEE MEMBER OF MEDICAL COUNCIL OF INDIA
• “TEACHER OF THE TEACHER AWARD” by Delhi Gynaecologist forum 2018
• Life time achievement Award from FOGSI (national organisation of Gynaecologists )
*IMA medical Association
*Lady Harding Medical Collage
*Delhi gynaecologist forum
• *ISAR ( Delhi)
• Founder chairman (for a decade )PushpanjaliCrosslayHospital now Max vaishali
• Founder & director of Lifecare Centre & IVF which is serving east Delhi for last 27 year for GYNAE
care , IVF ,Bariatric surgery , Advanced Lap / Hyst Surgery
• FOUNDER & SECRETARY GENERAL OF DELHI GYNAECOLOGIST FORUM ( 2000 )
• Recognised as Great Medical social worker is behind National movements of Female foeticide ,
Anamia Free India , Adolescent Health , Save uterus, Save girl child etc
NOW HER PASSION 360 * CARE ,DOCTORS TRAINING & SAFETY OF DOCTORS
DR. SHARDA JAIN
M.D. (PGIMER), MNAMS,FICOG,FIMSA,
DHM, QM &AHO
PGDMLS (SYMBIOSIS)
Presented at Moradabad CME 2018

3. Name : Dr Jyoti Agarwal
Ex Hardonian Throughout
Qualification : MBBS (Gold Medalist)
M.D (Gynae & OBST )
Designation : Senior consultant & Director
Lifecare Centre & Lifecare IVF
Institution : Lifecare Centre
11 Gagan Vihar Delhi – 51
Area of Interest : IVF, Infertility , Ultrasound
Academic Activities : * Vice President of D.G.F.(East)
*Certified trainer for infertility ,IVF & ultrasound
*Participated in various national CME &
workshop as a faculty
Dr. Jyoti Agarwal

4. …Caring hearts, healing hands

5. …Caring hearts, healing hands
Uterine fibroids
Elephant in the room

6. Uterine fibroids
are
benign tumors
that grow on or
within the muscle
tissue of the uterus.
Uterine Fibroid
(also known as Uterine Leiomyomas; Myomas)
…Caring hearts, healing hands

7. TYPES OF FIBROIDS
…Caring hearts, healing hands

8. CATEGORY SIZE OF FIBROID
SMALL < 3 cm
MODERATE 3-5 cm
MODERATELY
LARGE
6-10 cm
LARGE
>10 cm
FIBROIDS- SIZE
…Caring hearts, healing hands

9. Category Location of fibroid
Intramural
fibroids
Grows on muscle
wall of uterus
Submucosal fibroids
Grows inside the
endometrium
Subserosal
fibroids
Grows on the outer
surface of the uterus
Pedunculated
Grow on small stalks
inside or outside the
uterus
FIBROIDS- LOCATION
…Caring hearts, healing hands

10. FIBROID- SYMPTOMS
Symptoms can be influenced by the
location,
size &
number of fibroids.
…Caring hearts, healing hands

11. FIBROID- SYMPTOMS

12. UTERINE FIBROIDS – CAUSES & RISK FACTORS
Causes & Risk
Factors of
Uterine Fibroids
Genetics &
Family History
Hormonal Imbalance
Estrogen
Progesterone
Environmental & other
factors
Obesity
Early Menarche
Race
Non Vegetarian Diet
…Caring hearts, healing hands

13. UTERINE FIBROIDS - DIAGNOSIS
• Pelvic examination followed by
abdominal or transvaginal
ultrasound to confirm its presence
• Hysteroscopy: very useful
to detect Submucosal fibroids
• Pelvis MRI
• Pelvic laparoscopy
…Caring hearts, healing hands

14. PATHOPHYSIOLOGY OF
TERINE FIBROIDS
Progesterone
plays a vital role in promoting uterine fibroid growth
…Caring hearts, healing hands

15. PATHOPHYSIOLOGY
OF UTERINE FIBROIDS
Progesterone promotes development and
proliferation of fibroid cells
& estrogen is required only for up-regulation of
progesterone receptors.
…Caring hearts, healing hands

16. PATHOPHYSIOLOGY OF UTERINE FIBROIDS
Inhibits apoptosis
in fibroid cells
Increases
Angiogenesis
Increases fibroid cell
proliferation
Increases fibroid size and volume
BCL-2: B- Cell Lymphoma (Anti- apototic Protein)
EGF- Epidermal Growth Factor – cell stimulator and differntiator
TNF- alpha cell
…Caring hearts, healing hands

17. …Caring hearts, healing hands
To Stop Fibroid Growth
Ulipristal Acetate

18. 1.
2.
3.
Age & Parity
Child bearing expectations
Extent & Severity of
Symptoms
4. Size, number & location of
myomas
5.
6.
Proximity of menopause
Risk of Malignancy
Current Therapies for uterine fibroids:
Are they Satisfactory?
• The management of symptomatic fibroids
has been traditionally surgical
• No medical therapy can completely eliminate fibroids
• However the quest for medical treatment of fibroid is on & on
• Choice of therapeutic modality depends on several factors
including :

19. UTERINE FIBROIDS – TREATMENT OPTIONS
…Caring hearts, healing hands

20. LIMITATIONS OF SURGICAL THERAPY
SURGERY LIMITATION
HYSTERECTOMY
Risk of surgical long term complication
Complete loss of fertility
MYOMECTOMY Potential uterine rupture
…Caring hearts, healing hands

21. LIMITATIONS OF SURGICAL THERAPY
NON- SURGERY LIMITATION
Uterine-artery embolization (It blocks blood
flow to fibroids in the uterus)
Fibroid recurrence
Potential ovarian failure
Fibroid recurrence
MRgFUS
(Magnetic Resonance-guided Focused
Ultrasound) Each sonication will destroy a
small area of the fibroid
High cost
Needs Interventional radiologist
No sufficient data for fertility
…Caring hearts, healing hands

22. …Caring hearts, healing hands

23. LIMITATIONS OF MEDICAL THERAPY
Medication Limitation
Combined Oral Contraceptive Thromboembolism
Weight gain
NSAIDs Lack of evidence in Fibroid symptoms
GI side effects
Tranexamic acid Cannot be taken for longer period
GnRH agonist (Leuprolide)
Causes hot flushes, vaginal dryness and
loss of libido
Decreases Bone Mineral Density
Increase risk of Osteoporosis
Androgen (Danazol) Causes acne, hirsutism and edema
ULIPRISTAL ACETATE
•May cause Liver dysfunction.
•Safety is a concerned in pre menopausal
women

24. ULIPRISTAL ACETATE
Now Lets talk about
Rise & Fall of

25. Ulipristal Acetate Approval
17
16th
Dec 2011 24 June 2013th
2014

26. Big blow to UPA on
7th August 2018

27. Summary of MHRA 9th August 2018
Rare but serious cases of liver injury, including cases of HEPATIC
FAILURE REQUIRING LIVER TRANSPLANTATION, have been reported
worldwide in women treated with Esmya (ulipristol acetate) for the
symptoms of uterine fibroids. An EU review of the available data
concluded that Esmya may have contributed to the onset of some of
the 8 cases of serious liver injury and has now finalised with a
number of measures to minimise this risk. In particular, more than
one treatment course is now authorised only in women who are not
eligible for surgery, and liver function monitoring is to be carried
out in all women treated with Esmya .

29. Low dose Mifepristone
A Promising Drug* in Medical
Management of Uterine fibroid
*Saudi J. Med. Pharm. Sci.; Vol-3, Iss-10B (Oct, 2017):1088-1096 …Caring hearts, healing hands

30. Low Dose Mifepristone-
Uterine Fibroids
Shows
proapoptotic/antiproliferative
action
Decreases LH/FSH
level
Shows antiproliferative
action
BCL-2: Beta Cell Lymphoma (Anti- apototic Protein)
EGF- Epidermal Growth Factor – cell stimulator and differntiator
TNF- alpha cell proliferator:
Decreases BCL-2 and increases
TNF alpha expression
Decreases fibroid size
and volume
Induces
amenorrhoea &
Inhibits ovulation
Stops Bleeding
Mifepristone
(Anti progesterone action)
Fibroids HPO Axis Endometrium
…Caring hearts, healing hands

33. Kulshrestha V, Kriplani A, Agarwal N, Sareen N, Garg P, Hari S, Thulkar J.
INTERPRETATION & CONCLUSIONS : Mifeprostone (10 & 25mg) caused symptomatic relief with more than 90% reduction in menstrual
blood . Greater myoma size reduction accured with 25 mg dose. Amenorrhoea was developed in 90- 95% patients which was reversible
. It can be a reasonable choice for management of uterine leiomyoma as it is administered orally . Cost – effective & has mild side
effects

34. Journal of Mid-life Health ¦ Jan-Mar 2013 ¦ Vol 4 ¦ Issue 1

36. The New Indian Journal of OBGYN. 2018 (January-June); 4(2)

37. Dr. Usha Krishna
Safety established by Indian references

38. Reduces
intra-operative
blood loss
Increases
Preoperative
Haemoglobin level
Reduces operative
time
Low Dose Mifepristone before
Fibroid surgery
Avoids Blood
Transfusion
Reduces fibroid size.
Making surgery
technically easier

39. Mifepristone Vs Leuprolide
Low dose Mifepristone- The Better choice, prior to surgery

40. Low dose Mifepristone Vs Leuprolide
Alternative to Leuprolide in perimenopause with uterine fibroids
Leuprolide: Patients Experience Bone Mineral Loss and Menopausal Symptoms

41. 1 tablet OD for 3-6 months
The first treatment course
should start during the first
week of menstruation.
Every day for 3-6
months
Low Dose Mifepristone:
Dosage and Administration

42. FAQ’s

45. Human Reproduction, Vol.1, No.1 pp. 1–10, 2009
SAFETY ESTABLISHED BY INTERNATIONAL REFERENCES

46. Human Reproduction, Vol.1, No.1 pp. 1–10, 2009
EFFECT OF LOW DOSE MIFEPRISTONE ON HORMONES

47. …Caring hearts, healing hands
Sharing
Experience
in
53 cases of
fibroids with
HMB after
35 yrs
at

48. 23
At 3 months:
60% patients “Much
improved” & at 6 M
80% improved”
• Using mifipristone prior to surgery : delays or avoids surgery by lastingly
improving symptoms, even after stopping treatment
•
•
Thus one can avoid surgery prior to menopause
20% patients lost to follow up or
underwent surgery
Our Experience
at Lifecare Centre

49. Take Home Message
LOW DOSE MIFEPRISTONE
…Caring hearts, healing hands
A Promising* drug

50. …Caring hearts, healing hands
LOW DOSE MIFEPRISTONE
It acts
The fact that mifepristone in has been use for medical
abortion for long time & safety so far is un questioned

51. Presented at Moradabad CME 2018

52. ADDRESS
11 Gagan Vihar, Near
Karkari Morh Flyover,
Delhi - 51
CONTACT US
9650588339
9599044257
011-22414049
WEBSITE :
www.lifecareivf.in
www.lifecarecentre.in
www.lifecareabs.in
ISO 14001:2004 (EMS)
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ISO 9001:2008
Helpline : 9599044257
Web.www.lifecareivf.in
Helpline : 9910081484
29
Year
In
your
service