From the Guidelines
Treatment options for calcified fibroids should prioritize watchful waiting for asymptomatic cases, and medical management with hormonal medications like GnRH agonists or tranexamic acid for symptomatic cases, considering the patient's reproductive goals and symptom severity. When considering treatment options, it's essential to weigh the benefits and risks of each approach, taking into account the patient's overall health, reproductive goals, and the severity of symptoms.
- For asymptomatic calcified fibroids, watchful waiting is often recommended as calcification typically indicates the fibroid is degenerating and becoming less active 1.
- Medical management may include hormonal medications like GnRH agonists (leuprolide acetate 3.75 mg monthly injections for up to 6 months) to temporarily reduce fibroid size and bleeding, or tranexamic acid (1000 mg three times daily during menstruation) to control heavy bleeding 1.
- Surgical options include myomectomy to remove just the fibroid while preserving the uterus, or hysterectomy for definitive treatment in women who have completed childbearing 1.
- Minimally invasive procedures like uterine artery embolization (UAE) can block blood flow to fibroids, though calcified fibroids may respond less effectively due to their already diminished blood supply 1.
- Focused ultrasound surgery (FUS) and radiofrequency ablation are newer options that use targeted energy to destroy fibroid tissue. The calcification process represents calcium deposition in degenerating fibroids, often indicating reduced growth potential, which explains why some calcified fibroids may require less aggressive intervention than actively growing ones 1. It's crucial to consider the most recent and highest quality evidence when making treatment decisions, and to prioritize the patient's quality of life, morbidity, and mortality outcomes 1.
From the Research
Treatment Options for Calcified Fibroid
- The treatment options for a calcified fibroid are similar to those for other types of uterine fibroids, and may include expectant management, medical therapy, or surgical treatment 2.
- Medical therapy to reduce heavy menstrual bleeding includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs 2.
- Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators are an option for patients who need symptom relief preoperatively or who are approaching menopause 2, 3, 4.
- Surgical treatment includes hysterectomy, myomectomy, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery 2.
Preoperative Medical Therapy
- Preoperative medical therapy with gonadotropin-releasing hormone agonists (GnRHa) may reduce uterine volume and fibroid volume, and probably increases preoperative haemoglobin levels, but probably also increases the number of adverse events 3.
- Selective progesterone receptor modulators (SPRMs) such as ulipristal acetate may also reduce uterine volume and increase haemoglobin level before surgery, and may reduce fibroid volume and fibroid-related bleeding 3, 4.
Role of GnRH Agonists and Antagonists
- GnRH agonists and antagonists may be used in the therapy of symptomatic uterine fibroids, with agonists used as a preparation for surgery and antagonists used as a drug for long-term use 5.
- GnRH analogs modulate the pulsatile release of GnRH, and may be used to reduce uterine fibroid volume and reverse related symptomatology 6, 5.