Pharmacotherapy of uterine fibroids

If there are no symptoms of uterine fibroids (non-cancerous smooth muscle tumours which grow in the uterus and its walls; Pic. 1 and 2) or if there are just slight symptoms which are not significantly affecting daily life of a woman, medical treatment is usually not necessary. Fibroids often shrink after the menopause and symptoms ease or disappear completely.

However, if the medical treatment is necessary, there are several possible options how to treat uterine fibroids by pharmacotherapy. Some of the options provides only symptomatic treatment and decrease the symptoms potentially related to fibroids by relieving the pain or heavy bleeding. Other of the options helps to shrink the uterine fibroids and thus to eliminate the primary cause. 

Contraceptive pills

It is a popular method of contraception. These pills stop an egg being released from the ovaries and thus to prevent pregnancy. Depending on the type of pills, they also make the menstruation bleeding lighter and may help reduce the period pain.

Anti-inflammatory drugs
The principle of non-steroidal anti-inflammatory drugs, such as ibuprofen, is that they reduce the body’s production of a hormone-like substance – prostaglandin, which causes the heavy periods. Anti-inflammatory drugs are not hormonal medication and they help relieve the pain related to fibroids or menstrual periods, but they don’t reduce bleeding caused by fibroids. Moreover, indigestion and diarrhoea are common side effects of these drugs.

Tranexamic acid
If contraception pills or progestogen pills or injection are not desired tranexamic acid tablets may be considered. This is a non-hormonal medication which helps to ease the heavy bleeding. The principle works on stopping the blood income in small vessels into the uterus lining and thus reducing blood loss approximately to a half of its amount.

Tranexamic acid tablets are taken three or four times a day during the menstrual period, for up to four days. As a side effects, indigestion and diarrhoea are possible.

Oral / injected progestogen
Progesterone, one of the most important progestogens in the body is possible to prepare in a synthetic way (man-made). Progesterone controls the uterine lining growth.

Taking progestogen may help to reduce heavy periods, by preventing the uterine lining grow quickly. Oral progestogen is usually taken as a daily tablet from day 5 to 26 of the menstrual cycle, counting the first day of the period as the day one. In form of injections, the progestogen is injected every 12 weeks for as long as treatment is required.

The side effects of taking progestogen may include weight gain or breast tenderness; furthermore the irregular bleeding or absent periods at injected progestogen.

Progestin-releasing intrauterine device (IUD)
Another option to oral or injected progestogen is a progestin-releasing IUD. It can also relieve heavy bleeding caused by fobroids as the previous options. Furthermore, it also prevents pregnancy. Such an example levonrgestrel intrauterine system (LNG-IUS) is provided.

Gonadotropin releasing hormone analogues (GnRHas)
If medication relieving the symptoms of uterine fibroids doesn’t help enough, gonadotropin releasing hormone analogues is a possible method how to eliminate the primary cause – it helps to shrink the fibroids.

GnRHas are hormones given by injection. They affect pituitary gland (pea-sized gland located at the bottom of the brain) which controls releasing gonadotropic hormones by reproduction system and make it blocking the production of estrogen and progesterone. Thus the menstrual cycle is stopped and the body is put into a temporary postmenopausal state. As a result, fibroids shrink and anemia (which often accompanies fibroids from heavy bleeding) improves. GnRHas are prescribed on a short-term basis. After the treatment, the fibroids may possibly grow back to their original size.

Even though that GnRHas stops the period, they are not a form of contraception. They don’t affect the chances of becoming pregnant after stopping their use.

As GnRHas stops the period and put a body into post-menopausal state-like, side effects, such as hot flushes, sweating, vaginal dryness, depressions or mood swings, may appear. A combination of GnRHas and low doses of hormone replacement therapy may be recommended to prevent the side effects.

Depending on the seriousness of the symptoms, the medical treatment may be only symptomatic or it can try to eliminate the primary cause – to eliminate the uterine fibroid itself. If the symptoms don’t affect too much everyday life, symptomatic treatment is preferable. 

Moreover, some methods have hormonal base, some others non-hormonal base. Hormonal-based symptomatic method may also provide temporary contraception effects during the period of method using. 

To eliminate the uterine fibroids and thus to eliminate the primary cause itself, some hormonal methods are possible. As the methods are based on the temporary period of tablet use, the fibroids may shrink however there is also a possibility that they can grow back to the original size after the medication ends.

Hormonal-based medical treatments may cause post menopausal states and side effects or premenstrual side effects such as weight gain, breast tenderness, hot flushes, sweating, vaginal dryness, depressions or mood swings. Non-hormonal based treatment may cause diarrhoea and indigestion as the side effects.

Many available therapies are effective for shrinking the size of fibroids and eliminating fibroids-related symptoms. However, long-term use of these agents in premenopausal women is not recommended because of side effects. 

The therapies may be effective as pre-operative treatments to reduce fibroids size and reduce menstrual-associated anemia.