Guest Author - Dr. Denise Howard
Fibroids or leiomyomata are smooth muscle tumors that are usually benign and are commonly found in the uterus. The most common presentation of fibroids is irregular or heavy uterine bleeding or prolonged heavy periods. Once the evaluation is complete then your gynecologist can discuss treatment options with you.
Just because fibroids are found, doesn’t mean that they need to be removed. Sometimes the problems that are thought to be due to fibroids can be controlled without actually removing the fibroids. There are many medical options available.
Non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, mefenamic acid and others reduce prostaglandin release in the uterus decreasing the pain associated with menstruation but also decreasing the blood loss by about 30%. To minimize gastrointestinal side effects, their use should be limited to 5 days.
Anti-fibrinolytic drugs have been proven to be helpful with menstrual blood loss, even if caused by fibroids. The FDA has approved Tranexamic acid for the treatment of heavy periods. Different agents are available in other countries. Women who are at increased risk of venous thromboembolism should avoid this medication.
Heavy bleeding with periods and painful periods can sometimes be controlled with hormones such as those used in hormonal contraception. Birth control regimens can result in shorter and less painful periods. There are a number of brands and dosing regimens. They are available in pills, patches, injections and internal rings. They can be used cyclically or continuously. There is also an intrauterine device and a cutaneous implant that delivers hormones. These provide coverage for 2-5 years. It is important to work with your doctor to identify the regimen that works for you. You should try them for at least 3 months to determine their effectiveness.
Other medical treatments include injectable therapies that trick the brain into thinking that you are in menopause. These are called GnRH agonist or antagonists. Goserelin, leuprolide and nafarelin are commonly used. If the ovary is temporally dormant, hormones are not produced and the fibroids gradually shrink. This can allow for temporary bleeding control and shrinkage, making other surgical therapies more effective. The absence menses also allows time for the body to resolve anemia. The most common side effect is hot flashes. Once this medication is stopped, the fibroids typically return to their pretreatment size unless a woman is close to menopause.
Misoprostol in a daily dose of 5-50 mg a day has been shown to shrink fibroids when used over a 3-6 month period. It is a progesterone receptor modulator. It works by blocking the progesterone receptors in the uterus. As a result the uterus and the fibroids shrink. Clinically studies demonstrate a reduction in the fibroid volume of 26-74%. Potential concerns are the development of endometrial hyperplasia and liver effects in a small percentage of women. Other selective progesterone receptor modulators and antiprogestins are being studied and hopefully will provide an even broader array of options for the treatment of fibroids.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!