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Other medical techniques for treating fibroids

What are the medical techniques for treating fibroids?

Many women with fibroids are told that the only possible option is a hysterectomy. This is clearly not true in the vast majority of cases and is likely on overused treatment by many gynecologists.

There are several medical options for managing fibroids.

Hormone Releasing Agonists

The most commonly used option for decreasing the size of fibroids and decreasing bleeding at the same time is a class of medications releasing hormone agonists (GnRHa). This class of medications after a few weeks of use ultimately tells the brain to stop telling the ovaries to produce estrogen.

Side effects can be easily counterbalanced and essentially eliminated with very low-dose hormone replacement. So, this sounds like a nice treatment. Yes? Not really. It really depends on a woman’s stage in life and reproductive goals. The problem with this treatment is that once the medication is stopped (it can really only be used for up to 1 year – and some sources say safely for only 6 months) the fibroids will predictably regrow. So, it is a poor long-term solution for younger women. It may be an acceptable solution for a woman closer to menopause who wants to decrease some of the pressure of bulk symptoms of fibroids and create a symptom-free “bridge” until she goes into natural menopause.

Levonorgestrel Intrauterine Device

The levonorgestrel containing intrauterine device (Mirena) may be effective in managing bleeding in women with fibroids. It may also be effective is decreasing the volume of smaller fibroids. While this sounds promising (and it is) the issue is that the fibroids do not disappear with this treatment and while the bleeding is lower than with no treatment it is certainly not eliminated. The other drawback to using the Mirena in women with fibroids is that there is a higher rate of expulsion versus women without fibroids. Expulsion is when the device comes out on its own. If your goal of treatment is simply to decrease bleeding and not decrease pain or pressure symptoms, in selected situations this may be an effective therapy for you.

Selective Estrogen Receptor Modulators

Another class of medications that may have showed promise in the treatment of fibroids in the selective estrogen receptor modulators (SERMs). It makes sense that decreasing the action of estrogen at the cellular level will decrease the growth of fibroids. This did not work out so well in 3 different clinical trials.

Selective Progesterone Receptor Modulators

In the future, we will likely start using a class of medication called selective progesterone receptor modulators (SPRMs). The SPRMs may be helpful because they decrease the action of progesterone at the level of the fibroid and may in the long term also decrease the action of estrogen (which clearly makes fibroids grow). One problem with these medications in experiments has been that a side effect may be overgrowth of the lining of the uterus (endometrium) and possibly a subsequently higher risk for developing endometrial cancer.