Medical Treatments for Fibroids
Currently there are not any available medicines that will permanently shrink fibroids.
Medicines can help control fibroid-related symptoms and are often used to reduce the size of fibroids.
In the absence of estrogen fibroids usually decrease in size.
Unfortunately, the effect is temporary, and the fibroids rapidly go back to their pre-treatment size when the medication is discontinued.
Drugs may also be recommended before surgery to make the surgery less difficult.
Heavy bleeding can often be decreased with birth control pills.
There are a number of medications in the family of GnRH agonists, which induce a temporary chemical menopause.
Gonadotropin-releasing hormone (GnRHa) agonists are used to shrink fibroids.
These are the most effective medications for the treatment of fibroids.
Lupron is the most commonly used drug in this class (Synarel, Zoladex are the others).
It is given by monthly injection in your doctor's office.
After you stop taking the drug, your period will return to normal in 1 to 3 months.
Unfortunately,if you do not have one of the other treatments, the fibroids will also return to their original size within a few months after cessation of GnRH agonist treatment
- reduce estrogen and progesterone levels
- reducing the blood flow to the fibroids
- making them smaller
Women who use these drugs will have their periods stop and will temporarily experience other symptoms of menopause, such as
- hot flashes
- vaginal dryness
since they induce a low-estrogen state.
Because fibroids are dependent on estrogen for their development and growth, induction of a low estrogen state causes reduction of tumor and uterus mass, resolving pressure symptoms.
(Uterine volume has been shown to decrease approximately 50% after three months of GnRH agonist therapy.)
In addition to decreasing the size of the uterus, treatment with GnRH agonists also stops menstrual flow (amenorrhea), allowing women with bleeding-induced anemia to significantly increase their iron stores.
Additionally, because bone also requires estrogen, long term use of GnRH agonists can significantly decrease bone density and can lead to bone loss (osteoporosis).
Because estrogen levels drop dramatically, the bone loss can be severe.
Currently, use of GnRH agonists alone for treatment of fibroids is usually limited to a short 1 to 3 month preoperative course to
- shrink the uterus
- facilitate a surgical procedure
- induce amenorrhea to improve hematologic condition before surgery.
In order to avoid osteoporosis, they should not be used for more than 3 to 6 months.
The combination of GnRH agonists and low doses of the steroid hormones estrogen and progesterone has been employed to safely extend the maximum duration of GnRH agonist therapy without sacrificing efficacy.
These regimens have been studied for use of up to 2 years.
Preliminary data suggest they may be safe and effective
- if the hormone dose is low (equivalent to menopausal replacement doses vs high dose birth control pills)
- if the GnRH-agonist is given alone first, allowing the uterus to shrink before the hormones are added.
This approach appears to maintain uterine shrinkage and control of bleeding while supporting other tissues such as bone and minimizing side effects such as hot flashes that accompany the low estrogen levels induced by GnRH-agonist therapy alone.
Birth control hormones
Birth control hormones (in the form of birth control pills, a skin patch or a vaginal ring) can help control heavy menstrual bleeding.
However, they do not shrink fibroids.