Part One | Part TwoBy: Jean Johnson for Fibroids1
In Part One of our discussion we considered types, symptoms, and prevalence. Now we’ll move on to first an exploration of causes and then a survey of drug therapies that gynecologists sometimes use before turning to surgical approaches or uterine fibroid embolization.
Causes
In a recent interview with Harjit Singh, M.D., Women’s Health Intervention specialist in Pennsylvania, we asked why women in their thirties and forties are the ones most likely to experience problems with fibroids. “We know so little about fibroids and their causes and natural progression,” Singh said. “Our only supposition is that the tumors likely start when women are in their twenties. The rate of growth is so slow, though, that fibroids generally don’t become symptomatic until patients are older. There are various things that could influence growth – hormone stimulation and things like that. But these factors are iffy, and there’s not a lot that tells us why fibroids are a certain size at a certain time.”
| Take Action |
Know the possible treatment options for fibroids:
Hysterectomy
Low-dose birth control pills
Anti-anemia drugs
Other courses of drug therapy
Myomectomy
High-frequency ultrasound
Myolysis
Cryomyolysis
Uterine fibroid embolization
Alternative treatments including acupuncture and herbal remedies
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As Singh implied, some researchers have looked at estrogen and progesterone, two reproduction hormones, and their relationship to fibroid growth. Produced by the ovaries, estrogen and progesterone stimulate development of the uterine lining for possible pregnancy. Since fibroids grow in the muscular wall of the uterus and their cells contain more estrogen and progesterone receptors than normal muscle cells, connections may exist even though studies have found nothing conclusive to date. Moving on from hormonal links to genetics, since African American women are at higher risk for fibroids with as many as 50 percent of the population experiencing symptoms, research has singled out heredity as a field of investigation. So far, gynecologist teams at least know that if a woman’s mother or sister has had fibroids, she is at risk for fibroids. As with hormonal factors, though, so little research has been done on the subject, that experts lack data that clearly substantiates genetic connections.
Other possible associations have also been suggested, although studies have come back with mixed results. Indeed, relationships between fibroids and obesity, oral contraceptives and pregnancy have all been considered, but thus far researchers have found little to corroborate the hypotheses.
Common Drug Therapies
Watchful waiting is the term given to the most conservative approach to treating fibroids. Because they tend to grow slowly and shrink after menopause, if symptoms patients experience are not severe, healthcare professionals may recommend watchful waiting. Generally, though, women that seek professional care are bothered by pelvic pain that doesn’t go away, overly heavy or painful periods, spotting or bleeding between periods, pain with intercourse, difficulty emptying the bladder or moving the bowel. Thus, by the time patients see physicians, they want symptomatic relief and some type of medical intervention.
Drug therapy is usually tried first starting with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin) or naproxen sodium (Naprosyn). If these medications don’t work, gynecologists may try putting patients on birth control pills to regulate cycles and bring heavy bleeding under control.
Other hormonal therapy is also an option although given long-term side effects including menopausal symptoms and moodiness, gynecologists generally reserve these approaches as temporary intervention. Still, since hormonal medications regulate the menstrual cycle, they can be helpful treating heavy bleeding and pelvic pressure associated with fibroids. Also while these drugs don’t eliminate the tumors, they may cause fibroids to shrink.
For example, gonadotropin-releasing hormone (GnRH), sold under names like Lupron and Synarel, produces the opposite effect to that of natural hormones and consequently causes levels of estrogen and progesterone to fall. The result is that menstruation stops, fibroids shrink and the anemia that is associated with heavy bleeding often improves.
Once GnRH therapy ceases, however, fibroids return to their original size within four to six months. Also, GnRH may have side effects that mimic menopause: Hot flashes, vaginal dryness, mood swings and osteoporosis. Further, the newer group of GnRH hormones used for fibroids are administered by injection by gynecologists. Gonadotropin-releasing hormone is sometimes used prior to surgery to reduce the size of fibroids and make removal easier.
While GnRH is a relatively benign approach to hormone therapy, gynecologists sometimes resort to other drugs if patients are willing. Androgens, for one, are produced by the ovaries and adrenal glands and are the so-called male hormones that used therapeutically can relieve symptoms of fibroids.
Another drug, Danozol, is a synthetic similar to testosterone. But while Danozol has been shown to shrink fibroid tumors and bring heavy bleeding and anemia under control, side effects are often more than women can tolerate. If weight gain and dysphoria – a state of feeling depressed, anxious or uneasy – isn’t enough, patients taking Danozol are warned that they may have acne, headaches, unwanted hair growth, and last but not least, a deeper voice.
