Tibolone reverses the cognitive effects caused by leuprolide acetate administration, improving mood and quality of life in patients with symptomatic uterine leiomyomas.  Palomba S, Orio F Jr, Falbo A, Oppedisano R, Tolino A, Zullo F.  Department of Obstetrics and Gynecology, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.   Fertil Steril. 2008 Jul;90(1):165-73. Epub 2007 Nov 14.

"OBJECTIVE: To investigate the effects of tibolone co-administration with GnRH agonist treatment in terms of cognition, mood, and quality of life. DESIGN: Randomized, controlled, single-blind, clinical trial. SETTING: Department of gynecology and obstetrics at a university in Italy. PATIENT(S): One hundred ten premenopausal women with symptomatic uterine leiomyomas. INTERVENTION(S): Six months of treatment with leuprolide acetate depot (11.25 mg IM, every 3 mo) associated with either tibolone (2.5 mg/d orally; group A) or placebo (1 tablet per d; group B). MAIN OUTCOME MEASURE(S): At baseline and after 6 months of treatment, uterine and leiomyoma sizes, leiomyoma-related symptoms, climacteric-like symptoms, cognition, mood, and quality of life. RESULT(S): At study entry, no difference was detected between groups in any parameters assessed. After treatment, the leiomyoma-related symptoms were significantly reduced in both groups, without any statistically significant differences between them. The Kupperman Index was statistically significantly higher in group B in comparison with baseline and group A. The cognition scores were statistically significantly different in comparison with baseline in group B, whereas no change was observed in group A. After treatment, mood and quality of life were statistically significantly improved in both groups, even though the improvement was significantly higher in group A than in group B. CONCLUSION(S): Tibolone administration reverses the deleterious effect on cognition that is caused by leuprolide acetate depot and improves mood and quality of life in patients who receive GnRH agonist for symptomatic uterine leiomyomas."  PubMed

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New anti-hormone drug shrinks uterus tumors
Reuters Health Wednesday, April 30, 2008 

NEW YORK (Reuters Health) - Treatment with CDB-2914, a drug that blocks the effects of the hormone progesterone, can markedly reduce the size of uterine fibroids tumors, benign growths that can cause bleeding and affect fertility, new research shows. 

Dr. Lynnette K. Nieman, from the National Institutes of Health in Bethesda, Maryland, and colleagues believe that CDB-2914 may be safer than other medical treatments for fibroids because the anti-hormone effect is relatively specific. 

Their trial, which is reported in the journal Obstetrics & Gynecology, included 18 women ages 33 to 50 with at least one fibroid greater than 2 centimeters in diameter. Six patients each were randomly assigned to CDB-2914, at 10- or 20-milligram doses daily, or to an inactive "placebo," for three cycles, or 90 to 102 days if no menstrual period occurred. 

Magnetic resonance imaging revealed that the fibroids shrunk by up to 36 percent with CDB-2914 treatment. By contrast, fibroids grew, by 6 percent on average,with placebo. CDB-2914 users also showed improvements in their fibroid symptoms, the report indicates. 

Just one patient experienced a menstrual bleeding during treatment with CDB-2914. Estrogen levels were reduced in the CDB-2914 group, but they were not low enough to cause problems, such as thinning of the bones, the authors note.  

"This small study suggests that CDB-2914 holds promise for the treatment of uterine (fibroids)," Nieman and her associates conclude. "Further investigation is needed to establish whether longer therapy provides additional (fibroid) reduction and whether a lower dose might be effective." SOURCE: Obstetrics & Gynecology, May 2008. www.nlm.nih.gov/medlineplus/news/fullstory_64042.html  

CDB-2914 for Uterine Leiomyomata Treatment: A Randomized Controlled Trial. Levens ED, Potlog-Nahari C, Armstrong AY, Wesley R, Premkumar A, Blithe DL, Blocker W, Nieman LK.  Obstet Gynecol. 2008 May;111(5):1129-1136   PubMed

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Firstly how long after Zoladex has stopped releasing can an UAE be performed.  Secondly, is a MRI necessary prior to the UAE?

Zoladex (like it's cousin Lupron, which is used in the U.S.A.) works in part by narrowing the Uterine Artery and it's branches.  I generally wait until after Lupron has had a chance to wear off (at least 4 weeks after the expected duration of effects) so that the effect on those vessels is reversed.  If the vessels are narrowed by the medication it increases the technical difficulty or the procedure, as well as the risk of both complications and technical failure (such as being unable to get into one vessel or not being able to deliver enough particles).

The main use of MRI is to exclude adenomyosis and confirm that the patient's only problem is fibroids.  It also excludes other pelvic pathologies.  I feel that it is essential as it can change management decisions in as much as 20% of patients.  – Dr. Robert Worthington-Kirsch

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Anastrozole, Tamoxifen, and Bone Loss on the ATAC Trial - Cancer.gov

Action of aromatase inhibitor for treatment of uterine leiomyoma in perimenopausal patients.  Hilário SG, Bozzini N, Borsari R, Baracat EC. Department of Obstetrics and Gynecology, University of São Paulo Medical School, São Paulo, Brasil.Fertil Steril. 2008 Feb 2 

"OBJECTIVE: To assess the effect of the aromatase inhibitor on patients with leiomyoma in the reproductive stage regarding reduction of uterine volume and control of symptoms.  CONCLUSION(S): Anastrozole proved to be effective in reducing the volume of the uterus-leiomyoma structure, leading to the control of symptoms connected with the disorder without changes in serum FSH and estradiol."  PubMed   Anastrozole

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Proellex:  Double-blind, placebo-controlled Phase 1/2 study for the treatment of Uterine Fibroids - Interim Assessment (Repros)

Repros’ Lead Product Proellex to Enter Phase 3 for the Treatment of Uterine Fibroid Indications  12/3/07

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Selective progesterone receptor modulator asoprisnil down-regulates collagen synthesis in cultured human uterine leiomyoma cells through up-regulating extracellular matrix metalloproteinase inducer.  Morikawa A, Ohara N, Xu Q, Nakabayashi K, Demanno DA, Chwalisz K, Yoshida S, Maruo T.Hum Reprod. 2008 Feb 15

"BACKGROUND A recent clinical trial demonstrated that selective progesterone receptor modulator asoprisnil is effective in reducing uterine leiomyoma volume. We investigated the effects of asoprisnil in vitro on the expression of the extracellular matrix (ECM)-remodeling enzymes and collagens in cultured leiomyoma and matching normal myometrial cells."   PubMed

Comparative effects of SPRM Asoprisnil (J867) on proliferation, apoptosis, and the expression of growth factors in cultured uterine leiomyoma cells and normal myometrial cells.  Reprod Sci. 2007 Dec;14  PubMed

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Goserelin versus Leuprolide before hysterectomy for uterine fibroids. Lim SS, Sockalingam JK, Tan PC.  Int J Gynaecol Obstet. 2007 Dec 27  PubMed
METHODS: A randomized study of 66 premenopausal women with fibroid uteri at least 14 weeks of gestation in a gravid uterus. Women were randomized to receive either subcutaneous depot 3.6 mg goserelin or 3.75 mg leuprolide every 4 weeks for a total of 3 doses. Hysterectomy was performed within 1 month of the last dose.

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Effects of Letrozole on proliferation and apoptosis in cultured leiomyoma cells treated with prostaglandin E(2). Han M, Kim JY, Park JE, Kim JM, Lee KS. Eur J Obstet Gynecol Reprod Biol. 2007 Dec 28  PubMed
CONCLUSION: The present results demonstrate that letrozole inhibits growth and induces apoptosis of leiomyoma cells by blocking the aromatase up-regulated by PGE(2) treatment. These findings support the need for further investigation of aromatase inhibitors as a medical treatment option in leiomyoma.