Uterine Fibroids and Hysterectomy - Medications

Highlights	Complications	Other Procedures
Introduction	Diagnosis	Hysterectomy
Causes	Lifestyle Changes	Resources
Symptoms	Medications	References
Risk Factors	Surgery

Medications

Because fibroid growth tends to stop and regress after menopause, the important reproductive hormones--estrogen, progesterone, or both--most likely play a critical role in their survival. Some agents that block either of these hormones are used to treat severe fibroids with some success.

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Contraceptives

Because fibroids are sensitive to estrogen and possibly progesterone, oral contraceptives, which contain these hormones, are not generally used to treat uterine fibroids. Early reports, in fact, suggested they might be a risk factor. Some studies conducted more recently on the newer low-dose OC combinations suggest they may be protective and may even reduce the risk of fibroids. It is not clear, however, how or if they should be used in women with fibroids. For example, a new form of IUD called the Levonorgestrel Intrauterine System (LNG IUS) is an excellent contraceptive that helps reduce uterine bleeding, even in women with fibroids, although it seems to have minimal effects on fibroids themselves.

Progestins (either natural progesterone or synthetic progestogen) are useful for women who clearly have heavy uterine bleeding caused by unopposed production of estrogen. Some may be useful for women with bleeding due to fibroids, although it is not yet clear which ones will be beneficial.

GnRH Agonists

Gonadotropin releasing hormone (GnRH) blocks the release of the reproductive hormones LH (luteinizing hormone) and FSH (follicular-stimulating hormone). As a result, the ovaries stop ovulating and no longer produce estrogen. GnRH agonists include goserelin (Zoladex), buserelin, a monthly injection of leuprolide (depot Lupron), and nafarelin (Synarel), a nasal spray. Such agents may be used to alone or in preparation for procedures used to destroy the uterine lining.

These agents may be used in the following situations:

As preoperative treatment three to four months before uterine surgery. In a major analysis, the use of GnRH agonists in such cases reduced fibroid size and uterus volume, helped correct any existing anemia due to blood loss, reduced blood loss during surgery, and reduced the duration of hospital stay. (Some experts question, however, whether the benefits outweigh the costs.)
For women with fibroids nearing menopause. (Such women only need them for a short period.)
Possibly helpful in improving subsequent fertility. (It is important to note, however, that women should not try to become pregnant while taking these drugs. They pose a risk for birth defects.)