Every patient with fibroids or adenomyosis is different. Although they may have common symptoms, such as bleeding or pain, each patient has specific goals for their treatment. These could include fertility preservation, pregnancy timing, and work requirements.
The team at the Weill Cornell Medicine Fibroid and Adenomyosis Program takes time to understand each patient and their symptoms. Our specialists educate our patients about the many treatment options available.
Medical therapies — which include hormonal and non-hormonal medications — are the most conservative treatment option. Most importantly, these therapies lessen symptoms, allowing patients the time to more thoughtfully plan further treatment.
What Are Medical Therapies?
Hormonal therapies for uterine fibroids and adenomyosis target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They do not eliminate fibroids but may shrink them. Hormonal medications include:
Oral contraceptive pills: a combination of estrogen and progesterone, may be prescribed to help control bleeding and anemia from fibroids and adenomyosis. These medications have also been shown to improve menstrual pain.
Progestins: A progestin-releasing intrauterine device (IUD) can relieve heavy bleeding caused by fibroids and adenomyosis. A progestin-releasing IUD will not shrink your fibroids or make them disappear, but it can control the bleeding and cramping that they cause.
In some cases, an IUD can eliminate the need for a more invasive procedure, such as a hysterectomy. Other progesterone-only medications include the Depo-Provera injection and norethindrone acetate, as well as medroxyprogesterone acetate oral medications.
Gonadotropin-releasing hormone (GnRH) agonists: GnRH agonists treat fibroids by blocking the production of estrogen and progesterone, putting you into a temporary menopause-like state. As a result, menstruation stops, fibroids shrink, and anemia often improves. They are a good option to improve anemia, decrease fibroids size, and optimize a patient's symptoms before major surgery. The most commonly prescribed GnRH agonist is leuprolide acetate. Leuprolide acetate is given as an injection into the muscle.
Gonadotropin-releasing hormone (GnRH) antagonist: GnRH antagonist, elagolix, is FDA-approved for the treatment of endometriosis. This medication, in combination with estradiol and norethindrone acetate, has recently been approved for treating heavy menstrual bleeding from fibroids.
There are several hormonal medications available that are not currently approved by the US Food and Drug Administration (FDA). You can speak with your doctor about the potential benefits and risks of these medications:
- Antiprogesterones, such as mifepristone and ulipristal acetate
Side Effects of Hormonal Therapies
Hormonal therapies are typically tolerated very well. Some patients may experience side effects such as acne, hot flashes, night sweats, headache, decreased interest in sex, changes in mood, nausea, dizziness, and weight gain.
If these side effects are bothersome, be sure to speak with your physician.
Non-steroidal anti-inflammatory drugs (NSAIDs): These non-hormonal medications may be effective in relieving pain related to fibroids and adenomyosis. Common NSAIDs are ibuprofen (found in Advil and Motrin) and naproxen (found in Aleve).
Tranexamic acid: This non-hormonal medication prevents enzymes in the body from breaking down blood clots. Tranexamic is usually taken during your menstrual period to ease heavy bleeding.
Other non-hormonal therapies: Vitamin and iron supplements may also be suggested for heavy menstrual bleeding and anemia.
Who is an Ideal Candidate for Medical Therapies?
Hormonal therapies can be useful in patients who have mild to moderate symptoms. Patients who have heavy bleeding and pain may benefit the most from hormonal management with oral contraceptive pills, intrauterine devices (IUDs), or GnRH agonists. For patients whose most significant symptom is heavy bleeding, progesterone medications — such as a levonorgestrel IUD — can help tremendously and may prevent the need for a hysterectomy.
Some patients may not be ready for a surgical intervention immediately but would like to have some relief from their abnormal bleeding and menstrual cramps. With hormonal therapies, patients can preserve their fertility and improve their overall health status until it is the right time for surgery.
Finally, a patient’s previous surgeries may make it necessary to limit the number of surgical procedures, and, for these patients, medical therapies can be incredibly useful.
Non-hormonal therapies can be beneficial for patients with mild to moderate symptoms. While they will not eliminate symptoms completely, they can lessen suffering and improve a patient’s quality of life. Non-hormonal therapies can also help those patients who may not want to take medication every day but still want some control over their symptoms.
While medical treatments will not cure fibroids or prevent the growth of new fibroids, they are the least invasive option. They can offer patients relief or reduction of symptoms so that they can consider reproductive goals or plans. Similarly, these treatments may improve symptoms of pain and abnormal bleeding associated with adenomyosis.
With medical therapies, it may take from one to three months to see an improvement in symptoms and quality of life. Medical therapies may provide adequate relief alone, or they can be a part of a treatment plan that includes other interventional or surgical therapies.
Why Choose Weill Cornell Medicine for Medical Therapies?
There are many treatment options available to women who suffer from fibroids or adenomyosis. Treatment options range from medical therapy to surgery, with many other options in between.
The team at the Weill Cornell Medicine Fibroid and Adenomyosis Program is proud to offer the latest treatment options and provide personalized care for our patients. By getting to know and listening to our patients, we understand their needs, as well as their most difficult symptoms.
Because our patients often seek treatment that will preserve their fertility, we discuss the least invasive treatment options, including hormonal and non-hormonal therapies.
Our team of minimally invasive gynecologic surgeons and interventional radiologists collaborates with other specialists in reproductive health, integrative medicine, and nutrition to help patients receive high-quality, personalized care.