Ulipristal acetate and surgical treatment of uterine fibroids. Differentiation of approaches based on updated instructions for use

In August 2021, the Ministry of Health of the Russian Federation approved new instructions for using Esmya (ulipristal acetate (UPA)). The updated guidelines indicate that UPA may be used as a course therapy for symptomatic uterine fibroids when uterine artery embolization and/or surgical treatment of uterine fibroids are inapplicable or ineffective. This article clinically examines and substantiates these situations and those where the use of UPA is inappropriate. Conclusion. UPA may be used: 1) in type 2 uterine fibroids to transform it into type 1, which allows safe hysteroscopic myomectomy; 2) in reccurrence of uterine fibroids after abdominal myomectomy; 3) in high risks of any surgical intervention; 4) in patients unprepared for surgery for various reasons. © 2022, Voprosy Ginekologii, Akusherstva i Perinatologii. All rights reserved.