Medical therapy can in some cases reduce the need for an operation but often it is not a long term solution. The drugs used can be divided into 2 groups: oral non-hormonal and hormonal (in various formulations). Summary of the available choices for medical therapy is shown below:
It reduces oestrogen and progesterone levels and blood flow to the fibroids to shrink them. It works by temporarily stopping the menstrual periods and put you in the menopausal state.
Often, GnRHa treatment is given 3 to 4 months to shrink the fibroids before myomectomy or hysterectomy (in order to avoid midline incision, anaemia, blood transfusion), and also as a "short-term" treatment for women nearing the menopause (i.e. late peri-menopause) to reduce the bulk. Clinical evidence showed that up 30% reduction in fibroid size was achieved after a 6 month treatment of GnRHa.
A temporary treatment only: Once GnRHa treatment stops, the fibroids will return to their former (original) size.
GnRHa also reduces blood loss and relieves pelvic pressure, urinary frequency, nocturia and constipation.
The most commonly prescribed GnRHa is Zoladex which is injected either every month or 3-monthly and can be given up to 6 months maximum.
The major side-effect is severe bone thinning leading to osteoporosis. Some clinicians prescribe tibilone, raloxifene as "add-back" to minimise this bone loss.
Other adverse effects include symptoms of menopause (hot flushes, headache and vaginal dryness), irregular bleeding, depression, hair loss and musculoskeletal stiffness.
Reduction in fibroid size occurs more quickly compared to GnRH agonist.
Commonly, it is used as pre-operative in young women and before peri-menopausal women.
A typical example: Cetrorelix.
Side effects include hot flushes, amenorrheic (absence of menstrual periods). Normal periods return within one month of discontinuation of treatment.
Short term therapy only.
Fibroid regrows after stopping the medication.
Male hormones (androgens)
They can slow or stop the growth of fibroids and offer symptoms relief. Drugs like Danazol can reduce the size of the fibroids and the womb, and stop
the periods and anaemia. However, its side-effects are off-putting for many women.
The side-effects include weigh gain, depression, anxiety, oily skin and hair, deepening of the voice, headache, fatigue, hair loss, growth of facial and body hair, blood clots and liver problems.
Exogenous progestins
Exogenous progestins, taken orally, are often used to reduce bleeding but have no effect on fibroid size.
(a) Medroxy-progesterone acetate (Provera) 5-10 mg once a day, or
(b) Megestrol acetate 10-20 mg daily.
Either one is prescribed in the first 10-14 days of the menstrual cycle. Usually, bleeding is regulated after 1-2 cycles. Provera can also be administered as a single injection (150 mg intramuscular) once every 3 months (Depo-Provera). It is best to see first whether you show any adverse side effects (weigh gain, depression, and even irregular bleeding) to the oral dose before trying the injection, because the effect of one injection lasts three months.
Medicated IUS
Medicated IUS is only suitable for heavy bleeding caused by fibroids with the fibroid uterus (womb) size of less than 12-week pregnancy with no distorting intracavity fibroids.
Mainly, IUS treats heavy period symptoms.
The procedure involves inserting an IUS (coil) into the uterus. This device delivers the hormone to decrease the blood flow to the fibroid preventing it developing.
It has not been proven effective in reducing the size of the fibroids.
It may reduce your chance of requiring surgery or other medical treatment.
Side effects include irregular bleeding which can last up to six months, acne, headache, breast tenderness and in rare cases your period may stop altogether.
MIRENA® is the most commonly fitted coil in UK for control of heavy bleeding in fibroid patients. It does NOT reduce the fibroid size.
It is a plastic coil which slowly releases levonorgestrel into the womb. Mirena coil can only used in women with fibroid uteri (womb) that is not more than 12 weeks pregnancy size. At the time of writing, Mirena is only licensed for heavy menstrual bleeding and NOT for fibroid treatment.
Under TRIAL medical therapy
Summary: Under TRIAL Medical Therapy
Product
Outcome on fibroid size
Outcome on abnormal uterine bleeding
Outcome on fertility
GnRHa
Ganirelic (subcutaneous Injection daily for 6 months)
Decrease 30-40%
Decrease
Contraceptive
Mifepristone (RU486) [Anti-progestin]
5mg daily for 6 months
Decrease 40% Decrease uterine volume by 40%
Decrease (risk of endometrial hyperplasia)
Contraceptive
SPRM
Asoprisnil (10mg daily for 6 months)
Decrease
Decrease
Contraceptive
Aromatase Inhibitors Anastrozole, CDB-2914
Decrease
Decrease
Contraceptive
Mifepristone
Doses of Mifepristone 5-50 mg/daily in clinical trials over 6 months show significant decrease in symptom severity and increase in quality of life questionaire.
Major side-effects for Mifepristone include cystic granular dilation of the endometrium, hot flushes, headache, nausea, mood swings, diarrhoea, decreased libido, weakness, fatigue, endometrial hyperplasia (thickening) and increased liver enzymes.Long term effectiveness and tolerability are currently unknown.
Asoprisnil
Doses of Asoprisnil 5-25 mg/daily in clinical trials in 129 women with fibroids show dose dependent reduction in uterine bleeding with 70% women in dose group 25mg/daily becoming amennorhea.
Side-effects for Asoprisnil include bloating, flatulence, breast pain, hot flushes and night sweats.There are some incidences of asymptomatic ovarian cysts. Long term effectiveness and tolerability are currently unknown.
CDB-2914 (Ulipristal)
It has similar chemical structure to mifepristone and is current under clinical trial in USA. At daily dose 10 mg and 20 mg over 3 months, fibroid size is reduced by 21-36% with a single case of dilated cystic hyperplasia. Long term effectiveness and tolerability are currently unknown.
Ulipristal is mainly evaluated as an emergency contraception.
Recent media coverage on its possible application in fibroids is found in Nursingtimes.net. Further update on the clinical trial progress can be found by visiting ClinicalTrials.gov or Current Controlled Trials (UK) using term "CDB-2914" or "Ulipristal".
Author:Dr Nicki On, PhD, MRPharmS. The information on this page has been peer-reviewed by Dr Rajesh Varma, MA, PhD, MRCOG. Dept of Obstetrics and Gynaecology, Guy's and St. Thomas' NHS Foundation Trust, London SE1 7EH, UK.
DISCLAIMER
This website provides primarily information which is intended for educational purpose only.
All contents within British Fibroid Trust should not be treated as a substitute for the medical advice of your own doctor or gynaecologist or any other health care professional. Medical decisions must be made in consultation with a qualified gynaecologist or specialist based on a complete medical history, physical examination and diagnostic results. British Fibroid Trust is not responsible or liable for any diagnosis made by a user based on the content of our website. British Fibroid Trustdoes NOT endorse any specific gynaecologist or radiologist and we urge you to seek the advice of your GP or local gynaecologist when deciding your treatment choices.
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This page was last modified on Sunday 11 July 2010 02:00 am.
