Uterine Fibroids (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Uterine fibroids facts
- What are uterine fibroids?
- What causes uterine fibroids and how common are they?
- What are the symptoms of uterine fibroids?
- Do untreated uterine fibroids pose a risk?
- What are the usual ways of diagnosing uterine fibroids?
- What is the treatment for uterine fibroids?
- Surgery for fibroids
- Medical treatment for fibroids
- What are the risks of uterine fibroids during pregnancy?
- Uterine Fibroids Slideshow
- Endometriosis Quiz
- Infertility Treatment Slideshow
- Find a local Obstetrician-Gynecologist in your town
Medical treatment for fibroids
Non-surgical techniques are usually hormonal in nature and include the use of drugs that turn off the production of estrogen from the ovaries (GnRH analogs). These medications are given for three to six months and induce a hypoestrogenic (low estrogen) state. When successful, they can shrink the fibroids by as much as 50%. Side effects of these drugs are similar to the symptoms of the perimenopause and can include hot flashes, sleep disturbance, vaginal dryness, and mood changes. Bone loss leading to osteoporosis after long-term (6 to 12+ months) use is the most serious complication. This may be treated with hormonal add back therapy. These drugs may also be used as preoperative treatment for large leiomyoma to shrink them in order to make the operation less difficult and reduce surgical risk.
Mifepristone (RU-486) is an antiprogestin drug that can shrink fibroids to an extent comparable to treatment with the GnRH analogs. This drug, sometimes known as the "morning-after pill" is also used to terminate early pregnancy. Treatment with mifepristone also reduced the bleeding associated with fibroids, but this treatment can be associated with adverse side effects such as overgrowth (hyperplasia) of the endometrium (uterine lining). Mifepristone is not approved by the US Food and Drug Administration (FDA) for the treatment of uterine leiomyomas, and the required dosages (different from those used for termination of early pregnancy) have not been determined.
Danazol (Danocrine) is an androgenic steroid hormone that has been used to reduce bleeding in women with fibroids, since this drug causes menstruation to cease. However, danazol does not appear to shrink the size of fibroids. Danazol is also associated with significant side effects, including weight gain, muscle cramps, decreased breast size, acne, hirsutism (inappropriate hair growth), oily skin, mood changes, depression, decreased high density lipoprotein (HDL or 'good cholesterol') levels, and increased liver enzyme levels.
The administration of raloxifene (Evista), a drug used to prevent and treat osteoporosis in postmenopausal women, has been shown to decrease the size of fibroids in postmenopausal women, but results with this therapy in premenopausal women have been conflicting.
Learn more about: Evista
Low dose formulations of oral contraceptives are also sometimes given to treat the abnormal bleeding associated with fibroids, but these do not shrink the fibroids themselves. Use of oral contraceptive pills has been associated with a decreased risk of developing fibroids, so some women may benefit from their use for this purpose.
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