From the Guidelines
Treatment for uterine fibroids causing dyspareunia should prioritize medical management with GnRH agonists or antagonists, such as leuprolide acetate or elagolix, to reduce fibroid size and alleviate symptoms, as recommended by the most recent guidelines 1. When considering treatment options, it's essential to evaluate the patient's overall health, symptom severity, and reproductive plans. Medical management is often the first line of treatment, and GnRH agonists or antagonists are effective in reducing fibroid size and symptoms.
- Medical treatments include:
- Hormonal medications like GnRH agonists (leuprolide acetate 3.75 mg monthly injections for up to 6 months) or GnRH antagonists (elagolix)
- Oral contraceptives and progestins to manage bleeding
- Non-hormonal options like tranexamic acid (1300 mg three times daily during menstruation) and NSAIDs for pain relief Surgical options, such as myomectomy or hysterectomy, may be considered for severe cases or when medical management is ineffective.
- Surgical options include:
- Minimally invasive procedures like uterine artery embolization
- Myomectomy (removal of fibroids while preserving the uterus)
- Hysterectomy (complete uterine removal) for severe cases It's crucial to individualize treatment, considering the patient's age, desire for future fertility, and symptom burden, as well as the location and size of the fibroids, as those located near the cervix or in the lower uterine segment are more likely to cause painful intercourse 1.
From the Research
Treatment Options for Uterine Fibroids Causing Dyspareunia
- The treatment of uterine fibroids causing dyspareunia depends on various factors, including the size and location of the fibroids, the patient's age, and their desire to preserve fertility 2.
- Medical treatment options are available, including gonadotropin-releasing hormone agonists, selective progesterone receptor modulators, and progestins, which can help reduce symptoms such as abnormal uterine bleeding and pelvic pain 3, 4.
- Surgical options, such as myomectomy and hysterectomy, may be considered for women with symptomatic fibroids who have not responded to medical treatment or who wish to preserve their uterus 5, 6.
- Minimally invasive procedures, such as uterine artery embolization and radiofrequency ablation, may also be effective in reducing symptoms and preserving fertility 3, 2.
- The choice of treatment should be individualized based on the patient's specific needs and circumstances, and should take into account the potential risks and benefits of each option 6.
Factors to Consider in Treatment Decision-Making
- The size and location of the fibroids, as well as the patient's overall health and medical history, should be taken into account when selecting a treatment option 5, 2.
- The patient's desire to preserve fertility and their uterus should also be considered, as some treatment options may impact fertility or require the removal of the uterus 3, 6.
- The potential risks and benefits of each treatment option, including the risk of complications and the likelihood of symptom recurrence, should be carefully weighed and discussed with the patient 6, 4.
Emerging Treatment Options
- New medical treatments, such as selective progesterone receptor modulators, are being developed and may offer improved symptom control and fertility preservation 4.
- Minimally invasive procedures, such as magnetic resonance-guided focused ultrasound surgery, are also being investigated and may provide effective symptom relief with fewer risks and complications 3, 2.