Treatments for Uterine Fibroids
Uterine fibroids are benign tumors on the muscular wall of the uterus. Also called uterine leiomyomas or simply myomas, fibroids grow from the muscle cells of the uterus. They may either protrude from the inside to form submucosal fibroids, or appear on the outside covering of the uterus to form subserosal fibroids. When these fibroid tumors are contained within the muscular walls, they are called intramural uterine fibroids.
Uterine fibroids are very common, but in 30% to 40% of women they are asymptomatic. Only 25% of women with fibroid tumors experience fibroid symptoms, such as heavy vaginal bleeding, severe pelvic pain, lower back pain, constipation, frequent urge to urinate, infertility, and miscarriage.
Generally, treatment is not necessary if the fibroids are asymptomatic, but women who suffer from significant symptoms must immediately consult a doctor to get their fibroids treated. Fibroids can be treated either through medical treatment or via surgical treatment methods.
Why Use Medicines for Fibroids?
Medical treatments alleviate the symptoms of uterine fibroids temporarily. Medications may shrink the fibroids to a certain extent, but they do not eliminate them. Moreover, they are associated with side effects, which are often difficult to tolerate.
Medical treatment of fibroids is a good option for those women who are experiencing heavy menstrual bleeding, but women who are suffering from pressure symptoms caused by large fibroids may not benefit from any medicines currently available.
Researches are underway to develop new drugs that will be able to treat fibroids themselves, not just their symptoms. Until then, tried and tested medications are the only options available to lessen severe symptoms of fibroids.
Gonadotropin-Releasing Hormone (GnRH) Agonists
GnRH agonists are the foundation of medical treatment for fibroids. GnRH agonists, such as Lupron and Synarel, block the production of the female hormone estrogen, which results in temporarily stopping heavy bleeding as well as shrinking the fibroids.
GnRH medication is administered only under specific circumstances. For instance, a woman who is experiencing profuse menstrual bleeding and is suffering from profound anaemia is an ideal candidate for GnRH medication. It is likely that she will need blood transfusions during the surgery for removal of fibroids, but if she uses lupron for two to three months before the surgery to make her periods temporarily stop, along with an iron supplement, the anaemia will improve and the need for a blood transfusion will be reduced.
GnRH agonist is not a permanent treatment for uterine fibroids because the fibroids will grow back to their original size and, often larger, the moment the medication is discontinued. Moreover, GnRH agonists are associated with a number of unpleasant menopausal symptoms such as hot flashes, vaginal dryness, and bone loss.
Medical treatment of fibroids based on the administration of androgens is also quite effective. Androgens, also called male hormones, are produced both in men’s and women’s bodies, but they perform different functions.
In women, ovaries, fat cells, and adrenal glands produce androgens, which are primarily converted into the female hormone estrogen. When given as medical therapy, androgens can relieve fibroid symptoms, but this therapy is usually accompanied with numerous unwanted side effects.
Danazol, an androgenic steroid, works quite well on the symptoms of fibroids. It reduces the production of reproductive hormones in the brain and ovaries, disrupts the menstrual cycle and raises testosterone levels in the blood. In this way, it helps to shrink fibroid tumors, stop menstruation, correct anaemia and reduce the uterine size. But these benefits are coupled with unpleasant side effects, such as weight gain, acne, headache, unwanted hair growth and a deeper voice. For this reason, androgen therapy is not widely used.
Intrauterine Devices (IUD)
Typically, IUDs are used to prevent pregnancy, but they also provide some non-contraceptive benefits. A new IUD called Levonorgestrel Intrauterine System (IUS) releases 20 mcg of levonorgestrel directly into the uterus. Due to this hormonal feature, IUS yields non-contraceptive benefits, such as a reduction in menstrual blood loss and pain, as well as offering protection against the growth of fibroids.
Oral Contraceptive Pills
Uterine fibroids induce heavy menstrual bleeding, and combined oral contraceptive pills containing oestrogen and progesterone, along with birth control pills containing only progesterone, can help to reduce bleeding as well as regulate the menstrual cycle. However, birth control pills do not have any effect on fibroids, that is, they neither reduce them nor do they cause them to grow faster.
Non-Steroidal Anti Inflammatory Drugs
NSAIDs, such as Aspirin, and Nurofen, are typically given to alleviate pain, inflammation and prostaglandin levels, but they do not provide any help in curing or shrinking the fibroids.
Novel medical therapies, including progesterone-receptor modulators and somatostatin analogues, are being tested as possible future medicinal treatments. It is hoped that, in the future, medicinal treatments for uterine fibroids will be just as effective as the current surgical treatments.