From the Guidelines
Treatment for uterine fibroids should be individualized based on symptom severity, fibroid size, location, and the patient's reproductive plans, with medical management being the first line of treatment for most patients, as recommended by the most recent guidelines 1. The primary goal of treatment is to alleviate symptoms such as heavy bleeding, pain, and pressure, while also considering the patient's desire for future fertility.
Medical Management
Medical treatments include:
- Hormonal medications like GnRH agonists (e.g., leuprolide acetate 3.75 mg monthly injections for up to 6 months), which temporarily shrink fibroids by inducing a menopausal state but have side effects including bone loss 1.
- Oral contraceptives and progesterone-releasing IUDs (Mirena) can help control bleeding symptoms but don't reduce fibroid size 1.
- Non-hormonal options include tranexamic acid (1000 mg three times daily during menstruation) or NSAIDs for pain and bleeding management 1.
- Progesterone receptor modulators such as ulipristal acetate, which reduce both bleeding and bulk symptoms and can be administered intermittently, allowing for menstruation during medication breaks 1.
Surgical Management
Surgical options include:
- Myomectomy (removing fibroids while preserving the uterus) for women wanting future pregnancy 1.
- Hysterectomy (complete uterus removal) for those who don't desire future fertility.
- Less invasive procedures include uterine artery embolization, which blocks blood flow to fibroids, causing them to shrink, and focused ultrasound surgery, which destroys fibroid tissue using targeted sound waves. For patients with no desire for future fertility, medical management or uterine artery embolization (UAE) is usually appropriate for initial therapy, with surgical options considered if symptoms persist or worsen 1. Key considerations in treatment choice include the patient's symptoms, age, desire for future fertility, and fibroid characteristics. Many women with small, asymptomatic fibroids may only require monitoring rather than active treatment.
From the FDA Drug Label
CLINICAL STUDIES In a controlled study comparing leuprolide acetate 1 mg/day given subcutaneously to DES (diethylstilbestrol), 3 mg/day, the survival rate for the two groups was comparable after two years of treatment. The objective response to treatment was also similar for the two groups.
The treatment options for uterine fibroids may include leuprolide acetate.
- Leuprolide acetate is used in the treatment of uterine fibroids, as evidenced by the clinical study comparing it to DES (diethylstilbestrol) 2. However, the provided information does not fully address the range of treatment options available for uterine fibroids.
From the Research
Treatment Options for Uterine Fibroids
The treatment of uterine fibroids depends on various factors including the size and location of the fibroids, the age of the patient, symptoms, desire for future childbearing, and the experience of the gynecologist 3. The following are some of the treatment options available:
- Medical therapy: includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs to reduce heavy menstrual bleeding 3, 4
- Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators: used mostly preoperatively 3, 4
- Surgical treatment: includes hysterectomy, myomectomy (invasive and minimally invasive) 3, 5, 6, 4
- Non-surgical management: includes uterine artery embolization, and focused ultrasound surgery 3, 5, 6, 7, 4
Minimally Invasive Treatment Options
Minimally invasive treatment options are available for uterine fibroids, including:
- Laparoscopic myomectomy: a good option for symptomatic women with uterine fibroids who wish to maintain their fertility 5
- Uterine artery embolization: an effective treatment with low long-term morbidity, suitable for symptomatic fibroids in women who do not want to become pregnant 5, 4
- Magnetic resonance imaging-guided focused ultrasound surgery: a non-invasive treatment option 7
Considerations for Treatment
When choosing a treatment option, the following factors should be considered: