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decision pointShould I use GnRH-a therapy to treat uterine fibroids?

This is a general overview of issues that are important as you decide how to treat uterine fibroids. This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

If you are considering gonadotropin-releasing hormone analogue (GnRH-a) therapy for uterine fibroids, think about the following when making your decision:

  • GnRH-a therapy puts your body into a state like menopause for as long as you take it. This shrinks fibroids. After therapy, your fibroids may grow back.
  • GnRH-a therapy can cause serious side effects, such as bone loss. To limit side effects, therapy is limited to several months.
  • GnRH-a therapy is not usually used to relieve fibroid symptoms only, because its benefits are short-term. But if you are approaching menopause (when fibroids shrink), have heavy fibroid bleeding, or are planning surgery, GnRH-a therapy may be a reasonable option.
  • Pregnancy is not likely but is possible during GnRH-a therapy. Be sure to use a barrier method of birth control, such as a condom.

If you also have problems with infertility, you may wish to consider another method of treatment. For more information, see the topic Fertility Problems.

What are uterine fibroids?

Uterine fibroids are noncancerous growths in the uterus. Fibroids can grow on the inside of the uterus , within the muscle wall of the uterus , or on the outer surface of the uterus . Fibroids can alter the shape of the uterus as they grow. This can cause pregnancy problems. Over time, the size, shape, location, and symptoms of fibroids may change.

The cause of uterine fibroids is not known. But after fibroids develop, the hormones estrogen and progesterone appear to influence their growth. A woman's body produces the highest levels of these hormones during her childbearing years. After menopause, when hormone levels decline, fibroids often shrink or disappear.

Fibroids are also called myomas, leiomyomas, and fibromas.

What are the symptoms of uterine fibroids?

As women age, they are more likely to have uterine fibroids, especially from their 30s and 40s until menopause. About 80% of women have uterine fibroids by the time they reach age 50. Most have mild or no symptoms.1 But fibroids can cause serious problems that need treatment.

Uterine fibroids usually need treatment when they cause:

  • Anemia from heavy fibroid bleeding.
  • Ongoing low back pain or a feeling of pressure in the lower abdomen (pelvic pressure).
  • Blockage of the urinary tract or bowels.
  • Infection, if the tissue of a large fibroid dies (necrotic fibroid).

Fibroid problems that need treatment-but not with GnRH-a-therapy, include:

  • Infertility caused by fibroids that change the shape of the uterus or the location of the fallopian tubes.
  • Complications during pregnancy, such as miscarriage or premature labor.

How does GnRH-a therapy work?

A gonadotropin-releasing hormone analogue puts your body into a state like menopause for as long as you take it. This lowers your body's estrogen. This estrogen decrease:

  • Stops menstrual periods.
  • Stops the growth of and reduces the size of uterine fibroids.

GnRH-a therapy is not usually used to relieve fibroid symptoms only, because fibroids grow back fairly quickly after GnRH-a therapy ends. But it is sometimes used to shrink large fibroids before fibroid surgery or to stop heavy bleeding from fibroids.

For women who are approaching menopause (when fibroids shrink), short-term relief from GnRH-a therapy can be a reasonable option.

For more information, see the topic Uterine Fibroids.

What are the risks of medicines for the treatment of uterine fibroids?

A GnRH-a controls symptoms by lowering estrogen levels. This puts the body into a short-term state like menopause. Side effects that go away when the medicine is stopped include:

Pregnancy may be possible during and after therapy.

A woman's bones can weaken when she takes GnRH-a for longer than 6 months. After treatment, bone loss slows down. Then the bones get stronger, though they may not completely return to normal.2

Your choices are:

  • Use GnRH-a therapy to shrink fibroids before surgery, to stop heavy fibroid bleeding, or as a short-term therapy if you are nearing menopause.
  • Choose another method to treat uterine fibroids.

The decision about whether to use medicines to treat uterine fibroids takes into account your personal feelings and the medical facts.

Deciding about GnRH-a therapy
Reasons to use GnRH-a therapy to treat uterine fibroids Reasons not to use GnRH-a therapy to treat uterine fibroids
  • Your symptoms are severe.
  • Your symptoms are getting worse.
  • Other treatment-such as nonsteroidal anti-inflammatories or birth control pills-has not helped relieve your pain.
  • You are approaching menopause. GnRH-a therapy may offer you a temporary solution until fibroids naturally improve after menopause.
  • You are not planning to be pregnant any time soon.
  • You do not have any other conditions or diseases that would make treatment with medicines risky.
  • The medicines effectively treat uterine fibroids.

Are there other reasons that you might want to take GnRH-a therapy for uterine fibroids?

  • You have only mild symptoms.
  • Other treatment-such as nonsteroidal anti-inflammatories or birth control pills-has relieved your pain.
  • You are approaching menopause and can tolerate symptoms until then.
  • You wish to become pregnant.
  • GnRH-a therapy is only a short-term treatment, fibroids often grow back afterward, and you need long-term relief.

Are there other reasons that you might not want to take GnRH-a therapy for uterine fibroids?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about using GnRH-a therapy to treat uterine fibroids. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have severe symptoms of uterine fibroids. Yes No Unsure
My symptoms are gradually getting worse. Yes No Unsure
Heavy menstrual bleeding has caused me to become anemic. Yes No Unsure
My doctor wants to shrink my fibroids before doing surgery to remove them. Yes No Unsure
I have pain during intercourse. Yes No Unsure
I have painful urination or an inability to control the flow of my urine. Yes No Unsure
I wish to become pregnant. Yes No Unsure
I am approaching menopause. Yes No Unsure
Treatment with other medicines, such as nonsteroidal anti-inflammatories or birth control pills, has failed to relieve my symptoms. Yes No NA*
I have other medical conditions, such as osteoporosis, that would make the use of GnRH-a therapy risky. Yes No NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use GnRH-a therapy to treat uterine fibroids.

Check the box below that represents your overall impression about your decision.

Leaning toward using GnRH-a therapy to treat uterine fibroids

 

Leaning toward NOT using GnRH-a therapy to treat uterine fibroids

         

Citations

  1. Day Baird D, et al. (2003). Highly cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. American Journal of Obstetrics and Gynecology, 188(1): 100-107.

  2. Speroff L, Fritz MA (2005). The uterus. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 113-144. Philadelphia: Lippincott Williams and Wilkins.

Author Sydney Youngerman-Cole, RN, BSN, RNC
Last Updated August 11, 2009

WebMD Medical Reference from Healthwise

Last Updated: August 11, 2009
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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