What are the treatment options for uterine leiomyomas (fibroids)?

From the Guidelines

Treatment of uterine fibroids should be individualized based on symptoms, fertility desires, and fibroid characteristics, with medical management as the first line of treatment, including estrogen-progestin oral contraceptive pills, progestin-containing IUDs, and NSAIDs, as recommended by the most recent study 1.

Medical Management Options

• First-line medical management: estrogen-progestin oral contraceptive pills, progestin-containing IUDs, and NSAIDs, which reduce bleeding symptoms 1
• Second-line medical management: parenteral GnRH agonists (e.g., leuprolide acetate) and oral GnRH antagonists (e.g., elagolix, linzagolix, and relugolix), which reduce bleeding symptoms and tumor volume 1
• Progesterone receptor modulators (e.g., ulipristal acetate) may also be effective in reducing bleeding and bulk symptoms, but reports of hepatotoxicity are a concern 1

Minimally Invasive Procedures

• Uterine artery embolization (UAE) and myomectomy (surgical removal of fibroids) may be considered for patients with severe symptoms or large fibroids 1
• MRI-guided focused ultrasound and radiofrequency ablation are newer treatments that may be effective for some patients 1

Importance of Individualized Treatment

• Treatment should be tailored to the patient's specific situation, taking into account symptoms, fertility desires, and fibroid characteristics 1
• Consultation with a gynecologist is essential for developing the most appropriate treatment plan 1

From the FDA Drug Label

CLINICAL PHARMACOLOGY Leuprolide acetate, a GnRH agonist, acts as an inhibitor of gonadotropin secretion. Administration of leuprolide acetate has resulted in inhibition of the growth of certain hormone dependent tumors In pre-menopausal females, estrogens are reduced to post-menopausal levels

The treatment option for uterine leiomyomas (fibroids) is leuprolide acetate, a GnRH agonist, which can reduce estrogen levels to post-menopausal levels, potentially inhibiting the growth of hormone-dependent tumors such as uterine leiomyomas (fibroids) 2.

From the Research

Treatment Options for Uterine Leiomyomas (Fibroids)

The treatment options for uterine leiomyomas (fibroids) can be categorized into medical, surgical, and radiologically guided interventions.

• Medical treatment options include:
  • Progestogens
  • Combined oral contraceptives
  • Gonadotropin-releasing hormone agonists and antagonists
  • Selective progesterone receptor modulators (SPRMs) 3, 4, 5, 6
• Surgical interventions include:
  • Hysterectomy
  • Myomectomy (can be performed by hysteroscopy, laparoscopy, or laparotomy)
  • Hysteroscopic resection of submucosal fibroids
  • Subtotal hysterectomy 3, 4, 5
• Radiologically guided interventions include:
  • Uterine artery embolization
  • Myolysis
  • Magnetic resonance-guided focused ultrasound surgery
  • Radiofrequency ablation of fibroids
  • Endometrial ablation
  • High-Intensity Focused Ultrasound (HIFU) 3, 4, 5, 7

Factors Influencing Treatment Choice

The choice of treatment depends on various factors, including:

• Patient's age and fertility desires
• Number, size, and location of the fibroids
• Severity of symptoms
• Patient's overall health and personal treatment goals 3, 4, 5, 6