Uterine leiomyomas, or fibroids, are the most common benign tumor in reproductive aged women. Affected women may remain asymptomatic or may report symptoms related to abnormal uterine bleeding, infertility, or pelvic pain and pressure. Depending on a patient’s symptomatology and reproductive plans, treatment options include expectant management, medical management (hormonal and non-hormonal), or surgical management (myomectomy or hysterectomy). In those wishing to defer surgical management, non-hormonal therapies such as non-steroidal anti-inflammatory drugs and tranexamic acid have been shown to decrease menstrual blood loss. In patients with more symptomatic leiomyomas, hormonal therapies such as gonadotropin-releasing hormone agonists and selective progesterone receptor modulators are effective at reducing leiomyoma volume, uterine size, and menstrual blood loss. This manuscript will detail the available and emerging hormonal and non-hormonal treatments for symptomatic uterine leiomyomas.
Highlights
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Medical management should be considered as an alternative to surgery in the management of fibroids.
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Selection of medical management should be based on a patient’s symptoms.
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Gonodatropin-releasing hormone (GnRH) agonists and ulipristal acetate are effective in decreasing blood loss and fibroid size.
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Nonhormonal medications may also be beneficial in reducing menstrual blood loss due to fibroids.
Introduction
Uterine leiomyomas are common benign tumors that affect up to 70% of women of reproductive age. The majority of women with leiomyomas either remain asymptomatic or develop symptoms gradually over time . When patients are symptomatic, the nature of their complaints is often attributable to the number, size, and/or location of their fibroids. Bulky fibroids lead to symptoms as a result of pressure on the adjacent organs, such as the bladder, bowel, or ureters. These symptoms may include pelvic pain and pressure, dysmenorrhea, dyspareunia, incontinence, or constipation . By contrast, submucosal leiomyomas are more likely to cause abnormal uterine bleeding and impaired fertility . In the United States, it is estimated that the total economic impact related to fibroids ranges between six and 34 billion dollars, which includes the direct costs of health care as well as the indirect costs due to lost wages, disability, and obstetric complications.
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