Uterine Fibroids and Hysterectomy
For fibroid pain relief, women can use nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin, Advil, generic) or naproxen (Aleve, generic).
Prescription drug treatment of fibroids uses medicines that block or suppress estrogen, progesterone, or both hormones.
Oral contraceptives (OCs) are sometimes used to control the heavy menstrual bleeding associated with fibroids, but they do not help prevent fibroid growth. Newer types of continuous-dosing OCs reduce or eliminate the number of periods a woman has per year.
Intrauterine devices (IUDs) that release progestin can be very beneficial for reducing heavy bleeding. Specifically, the levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena), has shown excellent results. It is approved by the FDA to treat heavy menstrual bleeding. Many doctors now recommend the LNG-IUS as a first-line treatment for heavy menstrual bleeding, particularly for women who may face hysterectomy (removal of uterus). [For more information, see In-Depth Report #100: Menstrual disorders.]
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 the implant goserelin (Zoladex), a monthly injection of leuprolide (depot Lupron), the nasal spray nafarelin (Synarel), and buserelin (Suprefact), which is given either as a nasal spray or injection.. Such drugs may be used alone or in preparation for procedures used to destroy the uterine lining.
These drugs may be used in the following situations:
- As preoperative treatment 3 - 4 months before uterine surgery. The preoperative use of GnRH agonists reduces fibroid size and uterus volume, helps correct any existing anemia due to blood loss, and reduces blood loss during surgery.
- For women with fibroids nearing menopause, but only for a short period of time.
While GnRH agonists can reduce fibroid size by 30 - 90%, they have certain limitations:
- They are not permanent cures, and fibroids regrow after the drugs are discontinued.
- They cannot be taken by mouth.
- They are expensive.
- Long-term use of GnRh agonists causes bone density loss, which can lead to osteoporosis.
Before using these drugs, the doctor should be certain that no other complicating conditions are present, particularly leiomyosarcoma (cancer). The use of these drugs can delay treatment of the malignancy and cause severe complications.
Commonly reported side effects, which can be severe in some women, include menopausal-like symptoms. These symptoms include hot flashes, night sweats, vaginal dryness, weight gain, and depression. The side effects vary in intensity, depending on the GnRH agonist. They may be more intense with leuprolide and persist after the drug has been stopped.
The most important concern is possible osteoporosis from estrogen loss. Women should not take these drugs for more than 6 months.
GnRH treatments used alone do not prevent pregnancy. Furthermore, if a woman becomes pregnant during their use, there is some risk for birth defects.