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Uterine Fibroids—They Can Be Treated with Medication

HIGHLIGHTS:

  • Uterine fibroids are not life-threatening and don’t generally require treatment. If, however, you notice menstrual disorders or irregularities, you should see a doctor for diagnosis.
  • Treatment using Ulipristal Acetate medication is an effective alternative for uterine fibroids that do not require surgery, or for patients who are unable to undergo surgery due to health issues.
  • Treatment using medication can stop the majority of heavy menstrual bleeding within the first week of treatment, and is able to control over 90% of abnormal blood flow. It can also reduce the size of uterine fibroids and maintain reduced fibroid size after treatment is completed.

Treatment of Uterine Fibroids

 

Up to 25% of uterine fibroids are found in women aged 35 years and older, particularly in women who are already married but do not yet have children, who are overweight and who have a family history of uterine fibroids.

Uterine fibroids are not life-threatening.  Additionally, it has been found that, in most cases, uterine fibroids tend to be small in size, and thus do not usually show symptoms nor do they require treatment. If, however, you notice menstrual disorders or irregularities, such as heavy menstrual bleeding or frequent bleeding throughout the month, you should see a doctor for diagnosis, because a lack of treatment in such cases could result in infertility issues or anemia due to significant loss of blood. Additionally, if uterine fibroids occur during pregnancy, they may, in some cases, lead to premature births or miscarriage.

Types of Uterine Fibroids

Uterine fibroids can range in size from as small as a mung bean to as large as a watermelon. You can have multiple fibroids or just one. They are fairly hard and dense in nature, and can be found in almost every part of the uterus, as follows:

  • Intramural fibroids: These are the most common, and refer to uterine fibroids that grow within the muscular uterine wall. It can distort the uterine cavity or uterine wall, leading to abnormal symptoms.
  • Subserosal fibroids: These form on the outside of the uterus and may project into the surrounding outer uterine tissue layer. This type of uterine fibroid is usually asymptomatic, other than perhaps pressure on the bladder or rectum.
  • Submucosal fibroids: These are quite rare and are in such a position that, when they grow, they can push into the uterine cavity. They are usually found in the muscle beneath the inner lining of the wall. They can result in the distortion of the uterine cavity, and often cause menstrual disorders.

Causes of Uterine Fibroids

Uterine fibroids are a result of abnormal uterine muscle cell proliferation, although at present, the exact cause remains unknown. It is believed that the factors which have an impact on uterine fibroid development include:

  • Heredity: Those with a family history of uterine fibroids are at an increased risk of developing them.
  • Sex hormone abnormalities: Both estrogen and progesterone, two hormones that stimulate the development of the uterine lining, appear to promote the growth of fibroids. It has also been found that uterine fibroids tend to grow in size during pregnancy and shrink after menopause.

Symptoms of Uterine Fibroids

Most women with uterine fibroids don’t experience any symptoms, particularly if the fibroids are small and are detected by chance while the patient is undergoing an annual health checkup. Patients with large uterine fibroids, however, often have symptoms related to abnormal menstruation, such as heavy bleeding, irregular periods, pelvic pressure or pain, or chronic lower back pain. In some cases, fibroids growing and pressing on nearby organs can cause frequent urination or constipation. If the fibroid is particularly large, and can be felt in the pelvic area, it may cause swelling of the abdomen, similar to pregnancy.

Treatment of Uterine Fibroids

Once uterine fibroids have been found, patients often worry that they will need to undergo surgery to have them removed. In reality, however, the treatment for uterine fibroids varies from patient to patient. The most effective treatment is dependent upon the severity, size and location of the fibroids, as well as on the overall health of the patient.

Currently, there are options for diagnosing and monitoring the size of fibroids using high frequency sound waves or ultrasound. This includes both lower abdominal ultrasound and transvaginal ultrasound, which provide accurate, precise results. There are also medications available that provide effective treatment, allowing patients to avoid undergoing surgery.

 

Treatment of Uterine Fibroids with Ulipristal Acetate Medication

Treatment using Ulipristal Acetate medication is an effective alternative for uterine fibroids that do not require surgery, or for patients who are unable to undergo surgery due to health issues.

Currently, a medication known as ESMYA® (trade name) is available as a 5-mg tablet with the generic name Ulipristal Acetate. It is a drug in the Selective Progesterone Receptor Modulator (SPRM) class of medications with predominantly inhibitory effects on the progesterone receptor, exerting direct action on three parts, as follows:

  • Uterine Fibroids: The medication causes the size of the fibroids to be reduced by inhibiting cell proliferation and inducing apoptosis.
  • Pituitary Gland: The medication inhibits ovulation due to lower levels of progesterone and FSH; however, estrogen levels are maintained in the mid-follicular range in majority of patients.
  • Endometrium: The drug exerts a direct effect on the endometrium. This means that, for most patients, their menstrual cycle will stop until after treatment is stopped. When the Ulipristal Acetate treatment is stopped, menstrual cycles generally resume within 4 weeks.

Esmya has been approved for 2 main therapeutic indications:

1) Treatment of uterine fibroids prior to surgery

2) Used as a course of treatment for uterine fibroids in patients who are not eligible for surgery

The drug can stop the majority of heavy menstrual bleeding within the first week of treatment and is also able to control over 90% of abnormal blood flow. It can also reduce the size of the uterine fibroids and maintain reduced fibroid size after treatment is completed. The medication also helps to reduce pain and other various symptoms. The side effects are negligible, the most common being headaches and hot flashes, unlike other used medications such as GnRH agonists, which may lead to loss of bone mineral density and other postmenopausal symptoms from estrogen deficiency.

Treatment is carried out as a 12-week course. The first treatment course should start during the first week of menstruation. There should be a break of 2 menstrual cycles between the first course and the second retreatment course. Retreatment courses should start at the earliest time during the first week of the second menstruation following completion of the previous treatment course.

 

Patients Who Should Not Take Esmya Medication

  • Those who are allergic to major components or excipients in the medication
  • Women who are pregnant or lactating
  • Patients experiencing vaginal bleeding for unknown causes or due to causes other than uterine fibroids
  • Patients with uterine cancer, cervical cancer, ovarian cancer or breast cancer
  • Patients with abnormal liver function or liver disease

If uterine fibroids are detected, you should not be too worried, as they are not life-threatening. The growth of uterine fibroids can be monitored, and surgery is generally not required at all. Most importantly, there are medications available today that can successfully treat the condition. Treatment should only be carried out by a licensed medical professional.


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Boonsaeng Wutthiphan, M.D. Summary: Obstetrics And Gynaecology Obstetrics And Gynaecology