Pharmaceuticals for Fibroids 101
Alicia Armeli

pharmaceuticals-fibroids-101

Statistics show 30 to 50 percent of women with uterine fibroids will seek treatment for heavy periods, pelvic pain, and bulk symptoms like urinary frequency.1

To avoid surgery, many of these women will explore pharmaceuticals as their first line of defense. Categorized into two groups, the following medications have been shown to help ease fibroid-related discomfort, either by managing symptoms or reducing fibroid size.

Therapies That Manage Symptoms

 Non-Hormonal

  • An option to control pain and heavy bleeding is Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Ibuprofen—a frequently used NSAID—works by balancing hormones in the uterus, decreasing menstrual bleeding by as much as 40 percent.2 Gastrointestinal discomfort such as gas, stomach pain, and diarrhea are common side effects.3 Other more serious complications like stomach ulcers and worsening of asthma have been reported.2
  • Tranexamic acid, also known as Lysteda, is an antifibrinolytic agent used to control heavy bleeding. Taken on heavy flow days, antifibrinolytic medication slows the breakdown of blood in the uterine lining, thereby preventing heavy bleeding. Research has shown tranexamic acid to reduce menstrual blood loss by 40 percent.2 Side effects when taking tranexamic acid are mild and usually related to menstruation, such as back pain, headache, and fatigue.4 In rare cases, tranexamic acid breaks down fibroid tissue, potentially causing a low-grade fever and pelvic pain.5
  • Because menstrual blood loss can be severe, anemia is often a complication of fibroids. Iron and vitamin B12 are commonly prescribed supplements to support blood health and to treat anemia.6 

Hormonal

  • Hormonal contraceptives that contain both estrogen and progestin work by preventing ovulation and thinning the uterine lining. Research published in the American Journal of Obstetrics and Gynecology showed a significant reduction in menstrual bleeding among women using the birth control pill, the vaginal ring, or the transdermal patch.2 What’s more, these methods were seen to ease pelvic pain—especially when used continuously over time.2 Mild side effects can include nausea, headache, spotting, weight gain, and breast tenderness.2 Oral contraceptives that contain drosperinone could increase the risk for developing deep vein thrombosis (DVT)—a potentially life-threatening condition where blood clots form in the legs.7 Stroke and heart attack have also been reported.2
  • The Levonorgestrel-Releasing Intrauterine System (LNG-IUS) is a type of IUD that works by gradually releasing progestin to the uterine lining. Effective for 5 years, clinical studies have shown the LNG-IUS to reduce menstrual bleeding by 86 percent after 3 months and 97 percent after 1 year.2 Women with fibroids can use the LNG-IUS—if their fibroids don’t change the shape of the uterine cavity. A paper investigating LNG-IUS safety and efficacy published in the International Journal of Women’s Health reported that fibroids distorting the uterine cavity made inserting the device difficult and also increased the risk of it coming out of place.8 Overall, women using the LNG-IUS reported being satisfied, despite possible side effects like cramping, spotting, and discomfort during insertion.2,8
  • Danazol is a synthetic female steroid that thins the uterine lining and decreases menstrual bleeding by preventing the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This therapy option has been seen to reduce blood loss by up to 80 percent.2 However, because danazol also incites weak male hormonal activity, unpleasant side effects like acne, weight gain, and mild cases of facial hair have been reported.2

Therapies That Reduce Fibroid Size

  • Gonadotropin-Releasing Hormone agonists (GnRH-a) are medications that inhibit the body’s production of FSH and LH hormones. Subsequently, the ovaries stop producing estrogen, putting the body in a medically induced postmenopausal state. The absence of female hormones causes fibroids to shrink by 30 to 60 percent.2 Because long-term use is linked to bone loss, GnRH-a is commonly taken for no more than three to six months—unless small doses of estrogen and progestin are added back to protect bone density.9 Given its limited use, GnRH-a is often prescribed to stop heavy bleeding for a short period of time before menopause or to shrink fibroids before surgical removal.10 Menopausal symptoms like hot flashes, vaginal dryness, and depression have been reported side effects.2 Once the medication is discontinued, menstruation resumes and fibroids grow back.

Numerous other drugs, such as selective progesterone receptor modulators and aromatase inhibitors, are currently being studied for their efficacy; however, more research is needed.11

Although not curative, medical therapy is a noninvasive treatment option that can effectively manage fibroid symptoms, potentially making a woman’s need for surgery obsolete. It’s important to work with a gynecologist to find which regimen is best for you.

ABOUT THE AUTHOR   Alicia Armeli is a Health Freelance Writer, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering within her community.

 REFERENCES

  1. Soliman, A. M., Yang, H., Du, E. X., Kelkar, S. S., & Winkel, C. (2015). The direct and indirect costs of uterine fibroid tumors: a systematic review of the literature between 2000 and 2013. American Journal of Obstetrics and Gynecology, 213(2): 141-160. doi: 10.1016/j.ajog.2015.03.019
  1. Bradley, L. D., & Gueye, N. A. (2016). The medical management of abnormal uterine bleeding in reproductive-aged women. American Journal of Obstetrics and Gynecology, 214(1): 31-44. doi: 10.1016/j.ajog.2015.07.044
  1. Cleveland Clinic. (2016). Drugs, Devices & Supplements. Retrieved Aug 1, 2016, from http://my.clevelandclinic.org/health/drugs_devices_supplements/hic_Non-Steroidal_Anti-Inflammatory_Medicines_NSAIDs
  1. US National Library of Medicine. (2014). Tranexamic Acid. Retrieved July 31, 2016, from https://medlineplus.gov/druginfo/meds/a612021.html
  1. Ip, P. P., Lam, K. W., Cheung, C. L., Yeung, M. C., Pun, T. C., Chan, Q. K., & Cheung, A. N. (2007). Tranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: a clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas. The American Journal of Surgical Pathology, 31(8): 1215-1224.
  1. UterineFibroids.org. (2015). Oral Treatment Options for Uterine Fibroid Treatment. Retrieved July 30, 2016, from http://www.uterine-fibroids.org/oral-treatments.html
  1. US National Library of Medicine. (2015). Estrogen and Progestin (Oral Contraceptives). Retrieved July 31, 2016, from https://medlineplus.gov/druginfo/meds/a601050.html?
  1. Bednarek, P. H., & Jensen, J. T. (2009). Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS. International Journal of Women’s Health, 1: 45-58.
  1. UpToDate. (2016). Patient Information: Uterine Fibroids (Beyond the Basics). Retrieved Aug 1, 2016, from http://www.uptodate.com/contents/uterine-fibroids-beyond-the-basics
  1. University of Wisconsin-Madison School of Medicine and Public Health. (2016). Uterine Fibroids: Should I Use GnRH-A Therapy?. Retrieved August 1, 2016, from http://www.uwhealth.org/health/topic/decisionpoint/uterine-fibroids-should-i-use-gnrh-a-therapy/tv7259.html
  1. Song, H., Lu, D., Navaratnam, K., & Shi, G. (2013). Aromatase inhibitors for uterine fibroids. The Cochrane Database Systematic Reviews, (10): CD009505. doi: 10.1002/14651858.CD009505.pub2