Medical Treatments for Fibroids
Medicines can help control fibroid-related symptoms. The most effective medications for the treatment of fibroids are gonadotropin releasing hormone agonists (GnRHa), (including Lupron, Synarel, Zoladex). GnRH agonists cause a low-estrogen (menopause-like) state which causes reduction size of the tumor and uterus. Uterine size has been shown to decrease approximately 50 percent after three months of therapy with these medications. GnRH agonists also stop menstrual flow (amenorrhea), allowing women with bleeding-induced anemia to increase their iron stores.
Unfortunately, long term use of GnRH agonists can lead to bone loss, however when GnRH agonist treatment is stopped it is followed by a rapid regrowth of the fibroids and of the uterus to pre-treatment volume. Therefore the use of GnRH agonists alone for treatment of fibroids is usually limited to a short one to three month preoperative course to shrink the uterus in preparation for surgery or to improve anemia before surgery.
Other medical therapies including androgenic agents (e.g., danazol, gestrinone), progestins (e.g., medroxyprogesterone acetate, depomedroxyprogesterone acetate, norethindrone), Mirena IUD. Oral contraceptive pills have been used to control menorrhagia (prolonged and/or profuse blood flow) in women with leiomyomas, presumably by diminishing the endometrium (endometrial atrophy). Tranexamic acid (Lysteda) is an anti-fibrinolytic medication that does not contain hormones that can also be used to treat heavy bleeding. None of these medications decrease uterus or fibroid volume.
Uterine Fibroid Embolization/ Uterine Artery Embolization
Uterine fibroid embolization (UFE), also known as uterine artery embolization(UAE) is an alternative to surgery that involves placing a catheter through a small incision in the groin into an artery in the leg and guiding the catheter via x-ray pictures to the arteries of the uterus. Once there, the catheter is used to deliver agents that block off the blood vessels that feed the uterine fibroids. Total radiation exposure during this procedure is comparable to that in one to two CT scans. UAE does not remove uterine fibroids, but causes them to shrink by 30 to 50 percent.
Advantages of this procedure include no abdominal incisions and a shorter recovery time. After this procedure women may experience amenorrhea (lack of periods) depending on their age. Fibroids can recur or revascularize after this procedure, and up to 20 percent of women seek additional treatments in the five years following UAE.
Focused Ultrasound Treatment
MRI-guided focused ultrasound (FUS) is a noninvasive treatment option for uterine fibroids that destroys fibroids while preserving the normal uterus. Focused high-frequency, high-energy sound waves are used to target the proteins in fibroids, until they are destroyed. Used in combination with MRI, FUS allows physicians to precisely target and monitor therapy. A single treatment session lasts approximately 3 hours. Although fibroids are treated and ultimately decrease in size, they are not removed. Women are able to resume normal activity within a day of the procedure, however the long-term effectiveness of this treatment is not known and it is not recommended for women who want to preserve their fertility.
