By age 50 over 80% of women have been diagnosed with a uterine fibroid, although without a recent exam or ultrasound you may not even know you have one. Over half of all women with fibroids, however, will have symptoms that require treatment.
Surgery, in fact typically a hysterectomy, has been the most common treatment for a uterine fibroid, however there is a hopeful horizon of medical treatments being developed. Medical therapies for shrinking fibroids have been shown that fibroid tumors are hormone responsive enough that even fairly large tumors can have their size and function controlled and could shrink without surgery.
Surgery is safe and effective, both hysterectomies and myomectomies (to just remove the masses of fibroids themselves) can control the bleeding from fibroids. However, be hopeful that if you have heavy periods, anemia, pelvic pain, bulk symptoms from a large fibroid, or pain with intercourse you probably need to gab with your gyno as it’s important to get them treated.
One of the first steps will be to evaluate the fibroids. Speaking about your cycles, doing a pelvic exam, evaluating how much bleeding are going to be important first steps. Then testing the size, number and location of the fibroids. This can be done with ultrasound, saline infusion ultrasounds , CT scans or MRI. Almost no women need CTs, and very few will really need the MRI, in most one of the forms of ultrasounds will suffice. Endometrial biopsies to prove the lining of the uterus is not the problem to be treated in cases of pain, irregular bleeding, or heavy bleeding.
The list of medical treatments has actually been large, in spite of how common hysterctomies are. Oral contraceptives, medicated levonorgestrel IUDs, progesterones, NSAIDS, tranexamic acid, danazol (male hormone) and GNRH called lupron all may work to help uterine fibroids. The newest treatment is Oriahnn which is the GNRH Antagonist Elagolix combined with hormones that are in oral contraceptives. A treatment called Relugolix is also going to be available and is used in Japan for treatment of uterine fibroids as another treatment that is a GNRH Antagonist.
But the biggest hope are the selective progesterone receptor modulators called SPRMS. Progesterone causes fibroid cells to multiply and for the fibroid to grow. These compounds can directly affect a fibroid to cause it to shrink, and work on lowering the amount of hormone made by the ovaries, to reduce the amount of progesterone in a woman’s body. Mifepristone is the first SPRMS available in the US although it is not used yet for uterine fibroids. Several others are being studied includin one called ulipristal acetate and one called valaprisan, both studied in the most US trials. Ulipristal acetate is approved in Canada and Europe for a three month treatment sequence in patients who are candidates for a hysterectomy.
These medications work by direct effects on the fibroids, and they have unique effects on the uterine lining tissue, that is not cancerous.
The amount of menstrual bleeding women experienced when they have both bleeding uterine fibroids and anemia has been published in what is call the PEARL and VENUS research studies of the selective progesterone receptor modulator (SPRM), ulipristal acetate (UPA). The study did show significant promise with respect to uterine fibroid bleeding, about 80% of women will normalize their heavy bleeding after one 3 month treatment cycle. Many women will stop having bleeding altogether if they remain on medication.
Before any surgery, including hysterctomy, a woman is healthier if she can treat anemia effectively. To have the least risk, your count should be in the normal range. To this end pre-treating with a safe and effective uterine fibroid treatment is helpful. also shrinking a fibroid prior to surgery may allow for an easier surgery.
You and your personal physician have to plan what is best for you. Medications are on the horizon that may be good alternatives to you. Anyone with abnormal bleeding should seek a consultation with a gynecologist. We are accepting new patients at Women’s Health Practice, 217-356-3736.
