UTERINE FIBROIDS
MEDICATIONS
Some patients with uterine fibroids might choose management of the fibroids with medications. Medications can be a good treatment option for patients who have milder symptoms and are reluctant to undergo any of the more invasive treatment options. That said, bear in mind that medications are rarely a definitive treatment of uterine fibroids. While they can reduce the size of the fibroids, and help with symptoms such as pain or bleeding, medications don't eliminate fibroids. Moreover, different medications have different effect on fibroids.
Pain killers (non-steroidal anti-inflammatory drugs, NSAIDS)
Over-the-counter pain killers, such as ibuprofen (brand name: Advil) or aspirin can help relieve the pain associated with fibroids. Combination products that also contain caffeine or anti-histamines (such as pyrilamine maleate) are not the best choice because those agents don't actually have any pain relieving effect. Also, while pain killers can help with the pain, they don't reduce bleeds or the size of fibroids.
Tranexamic acid (oral)
This is a non-hormonal prescription medication that helps manage strong menstrual bleeds by slowing down the breakdown of blood clots, thus prohibiting bleeding. This medication can be a good choice if your main issue is with increased uterine bleeds and associated concerns, such as fatigue and anemia. If you do have anemia, you might consider also taking an iron supplement. However, because of these properties, this medication is contraindicated for patients with coagulative disorders or who are otherwise at risk of thrombosis. Moreover, while this medication can reduce bleeding, it does not always help with pain nor does it reduce the size of the fibroids.
Hormonal contraceptives
Both oral ("the pill") and implanted contraceptives ("IUDs") can help manage fibroid symptoms, particularly pain and bleeding. There are estrogen or progesterone-based contraceptive medications. Both have similar effects in that they reduce pain and bleeding, although progesterone-based products can be more effective because they completely stop the period for some women. However, these drugs usually don't have an effect on the size of the fibroids.
Gonadotropin-releasing hormone (GnRH) agonists
GnRH agonists (common brand names: Lupron, Eligard) are medications that act on the female reproductive hormone cycle. They mimic the function of the naturally occurring hormone GnRH. In the normal menstrual cycle, GnRH is released by the hypothalamus and binds to specific receptors in the pituitary gland, which then release other hormones, LH and FSH. These hormones in turn trigger the release of estrogen and progesterone in the ovaries, thus causing ovulation and eventually the menstrual bleed. The normal menstrual cycle depends on the cyclic administration of GnRH, i.e. the natural up and down regulation of GnRH during the menstrual cycle. GnRH agonists now mimic a continuous up-regulation of GnRH levels. This leads to a brief initial surge of LH and FSH in the pituitary gland, followed by a down regulation of these hormones. Down regulation of LH and FSH in turn leads to a down regulation of estrogen and progesterone in the ovaries. This is how GnRH agonists mimic a menopause-like state with very low levels of primary reproductive hormones. These low levels of estrogen and progesterone in turn cause the fibroids to shrink, thus also reducing menstrual bleeding and pain. However, because they induce a menopause-like state, GnRH agonists also cause menopause-like symptoms, such as hot flashes, vaginal dryness, mood swings and decreased bone density.