Uterine Fibroids Treatment Options
A first line therapy for some cases of Uterine Fibroids can entail our entirely non-invasive options such as watchful waiting or medical therapy. While these treatments do not cure uterine fibroids they are effective at temporarily managing the 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 both uterine fibroids and endometriosis target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may temporarily alleviate symptoms, by stopping the ovary's usual hormonal cycle and reducing estrogen levels. Medical therapy options include:
- Androgens (the so-called male hormones)
Your ovaries and your adrenal glands, located above your kidneys, produce androgens. Given as medical therapy, androgens can relieve fibroid symptoms. Danazol, a synthetic drug similar to testosterone, may effectively stop menstruation, correct anemia and even shrink fibroid tumors and reduce uterine size. However, occasional unpleasant side effects, such as weight gain, dysphoria (feeling depressed, anxious or uneasy), acne, headaches, unwanted hair growth and a deeper voice, make many women reluctant to take this drug.
- Oral Contraceptives
Oral contraceptives or progestins can help control menstrual bleeding, but they don't reduce fibroid size. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, are effective for heavy vaginal bleeding unrelated to fibroids, but they don't reduce bleeding caused by fibroids.
- Progestin-releasing intrauterine device (IUD)
If you have fibroids that don't distort your inner uterus, 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.
- 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 and anemia often improves temporarily. However, some women experience unpleasant menopause like symptoms such as hot flashes.
GnRH stands for Gonadotrophin Releasing Hormone and an agonist is a drug that acts the same way as the body's own hormone. The body normally makes GnRH in a small gland in brain center known as the hypothalamus. GnRH works in the the pituitary gland in the brain to control the release of hormones that act on the ovaries and adrenal glans to produce normal estrogen and stimulates the ovary to develop eggs leading to the normal menstrual cycle. If you give GnRH agonists, this floods the system and confuses the delicately controlled balance, leading to a complete block of egg development, estrogen production and menstrual cycle. It effectively makes you temporarily 'menopausal' for the time that you use the treatment and without the estrogen stimulation, fibroids shrink leading to decreased symptoms.
Lupron is commonly prescribed for women undergoing fibroid treatment particularly prior to surgery. The medication leads to a reduction in estrogen and effectively but temporarily shrinks the fibroids. This helps to resolve anemia, or a low blood count, prior to surgery reducing the risk of blood transfusion. Also, reducing the size of the fibroids prior to surgery many times will allow for a minimally invasive approach with laparoscopy or robotics. Since the treatment is limited to two months, almost all women will tolerate the nuisance side effects.
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.
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