Medical Therapy - Uterine Fibroids Treatment
A first line therapy for some cases of uterine fibroids can entail entirely non-invasive options with medical therapy. While these treatments do not cure uterine fibroids they can often manage symptoms of pain, pressure and bleeding often associated with fibroids. This can be best determined as the appropriate option for the patient during a fibroid consultation.
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may alleviate symptoms. Medical therapy options include:
- Progestin-releasing intrauterine device (IUD)
For fibroids that are not inside the cavity of the uterus, but rather in the uterine walls, a progestin-releasing IUD can relieve heavy bleeding and pain caused by the fibroids. A progestin-releasing IUD provides symptom relief only and doesn't shrink fibroids or make them disappear. This device can be placed in the office by a gynecologist during a visit. The progesterone intrauterine device may help bleeding but will not help pressure symptoms.
- Gonadotropin-releasing hormone (Gn-RH) agonists
To trigger a new menstrual cycle, a control center in your brain called the hypothalamus manufactures gonadotropin-releasing hormone (Gn-RH). The substance travels to your pituitary gland, a tiny gland also located at the base of your brain, and sets in motion events that stimulate your ovaries to produce estrogen and progesterone. Medications called Gn-RH agonists (Lupron, Synarel, others) act at the same sites that Gn-RH does. But when taken as therapy, a Gn-RH agonist produces the opposite effect to that of your natural hormone. Estrogen and progesterone levels fall, menstruation stops, fibroids shrink over several months and anemia often improves. This medication can only be used for a few months, and is not routinely used in reproductive- aged women as the effects are not long- lasting. However, for women nearing menopause who desire medical management, this may be an effective treatment option.
Side effects of GnHR agonists include: menopausal symptoms such as thinning of the bones, hot flushes, dry vagina, headaches, depression, loss of libido and night sweats. These side effects can be relieved, by adding back estrogen and progesterone, which does not affect the benefit of treatment. This is known as Add-back therapy. There is now evidence that the use of Add-back hormone replacement therapy (HRT) is effective in preventing the bone thinning and the unpleasant side effects of GnRH treatment.
- Non- Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs and a class of medication used to treat cramping and pain caused by fibroids. By targeting the specific hormones responsible for cramping, NSAIDS can help reduce a patient’s symptoms. These medications do not shrink fibroids and should be used at high doses for prolonged periods of time.
- Tranexamic acid (TXA)
TXA is a medication that works to promote blood clotting. By accelerating the blood’s ability to clot, the TXA works to decrease the amount of vaginal bleeding a woman has from fibroids. This medication is most often used in acute circumstances when a woman presents with heavy bleeding, and is generally not used long- term. It does not shrink fibroids or help with pain, but can prevent women from having excessive bleeding and anemia symptoms.
Other medications are being studied for treatment of fibroids, but for now are considered investigational (research).