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Jamaica Scientific Research Institute
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Conventional Treatments for Fibroids
 
  • If the fibroids are not causing any symptoms then treatment is not usually needed
  • Many women choose not to have treatment if they have symptoms that are tolerable. They chose only to monitor the growth of the fibroid periodically with a pelvic examination or ultrasound.
  • After menopause, fibroids often shrink and symptoms tend to go or ease
 

Treatment will depend on several things, including:
  • Age
  • General health
  • Severity of symptoms
  • Type of fibroids
  • Whether you are pregnant
  • If children are desired in the future

Medications to improve symptoms of Fibroids

  • Drugs to reduce heavy bleeding and pain
    • Intrauterine devices (IUDs) that release the hormone progestin
    • Tranexamic acid 
    • Birth control pills
  • Iron supplements to prevent or treat anemia due to heavy periods
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naprosyn for cramps or pain
  • Medications that that may promote shrinkage of the fibroids (see table below)

Surgery and other Procedures

  • Hysterectomy - removal of the uterus. This remains the only proven permanent solution for uterine fibroids. It ends the ability to bear children, and if the ovaries are removed, it brings on menopause.

 

  • Myomectomy - removal of the fibroids leaving the uterus in place. With myomectomy, there is a risk that the fibroid will recur. There are 3 types available:

    • Abdominal myomectomy. For multiple fibroids, very large fibroids or very deep fibroids. An open abdominal surgical . procedure is done to remove the fibroids
             
    • Laparoscopic or robotic myomectomy. For fibroids that are small and few in number. It employs the use of slender instruments inserted through small incisions in the abdomen to remove the fibroids from the uterus. The doctor views the abdominal area on a remote monitor via a small camera attached to one of the instruments. Use of a surgical robot now allows for removal of more fibroids or larger fibroids.
    • Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained inside the uterus (submucosal). A long, slender instrument (hysteroscope) is passed through the vagina and cervix and into the uterus. The surgeon can see and remove the fibroids through the scope. This procedure is best performed by a doctor experienced in this technique.

 


  • Focused ultrasound surgery. MRI-guided focused ultrasound surgery (FUS) is a noninvasive treatment option for uterine fibroids that preserves the uterus.

          This procedure is performed while inside of a specially crafted MRI scanner that allows doctors to visualize the anatomy, and then locate and destroy (ablate) fibroids inside the uterus without making an incision.

          Focused high-frequency, high-energy sound waves are used to target and destroy the fibroids. One or two treatment sessions are done in an on- and off- again fashion, sometimes spanning several hours.

  • Other minimally invasive procedures for fibroids

Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:

    • Myolysis. In this laparoscopic procedure, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids. The safety, effectiveness and associated risk of fibroid recurrence of myolysis and cryomyolysis have yet to be determined.
    • Endometrial ablation. This treatment, performed with a specialized instrument inserted into the uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of the uterus, either ending menstruation or reducing your menstrual flow. Endometrial ablation is effective in stopping abnormal bleeding, but doesn't affect fibroids outside the interior lining of the uterus.
    • Uterine artery embolization. Small particles (embolic agents) injected into the arteries supplying the uterus cut off blood flow to fibroids, causing them to shrink. This technique, performed by an interventional radiologist, is proving effective in shrinking fibroids and relieving the symptoms they can cause. Advantages over surgery include no incision and a shorter recovery time. Complications may occur if the blood supply to the ovaries or other organs is compromised.

Table below shows the Types of Medications used in the treatment of Fibroids. This list is not exhaustive.
Click here to view the chemical structures page.

DrugAction Common Side Effects
Androgens
such as
Danazol
Shrink fibroids and control symptoms by inhibiting production of steroids by the ovaries.  

This results in decreased secretion of estradiol (female sex hormone) and slight increase of androgens (steroids responsible for male characteristics)
  • Enhanced unwanted hair growth  (hirsutism)
  • Deepened voice
  • Acne and oily skin

Cabergoline
Cabergoline is an ergot alkaloidal drug that works by blocking the release of prolactin, a regulatory hormone, from the pituitary gland. 

Prolactin is thought to promote the growth of Fibroids.
  • Nausea
  • Vomiting
  • Stomach upset
  • Constipation
  • Dizziness
  • Tiredness
Gonadotropin-releasing hormone agonists (analogs)
such as
goserelin acetate, leuprolide acetate
Treats oestrogen dependent conditions by suppressing the production of both testosterone and oestrogen
  • Temporary increase in bone pain
  • Hot flushes
  • Headache
  • Stomach upset
  • Depression
  • Weight gain
  • Reduced sexual desire
Selective progesterone receptor modulators
such as
Ulipristal acetate, Progenta and Asoprisnil;

or the receptor antagonists such as Mifepristone

Modulators: May have mixed agonist/antagonist profiles that lead to selective stimulation or inhibition progesterone-like action in different tissues
Antagonists: Block of progesterone receptors
  • Abdominal pain
  • Temporary menstrual disorder
  • Headache
  • Nausea  
Endometrial thickening has limited the administration of the modulators to no longer than three to four months.
Aromatase inhibitors
such as
anastrozole

Works by partially lowering systemic oestrogen levels by either blocking the production of estrogen or blocking the action of estrogen on receptors.


They also partially inhibit locally over-expressed aromatase in fibroids.

  • Increased risk for developing osteoporosis
  • Joint disorders such as arthritis, arthrosis and arthralgia
  • Infertility
  • Aggressive behavior
  • Adrenal insufficiency
  • Kidney failure
  • Liver dysfunction

For a full profile on a drug you may be taking, visit Drugs.com or Rxlist.com and simply enter the name.

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