Medical Treatment of Fibroids

Jump to a section

• 0:03Introduction
• 0:24Hormonal therapies
• 1:53Progesterone-only methods
• 3:23Progesterone IUD
• 4:30Depo Lupron
• 6:23Uterine artery embolization

Full transcript

1. 0:03Introduction

   Hi, I'm Dr. Taz Varkey. Today I would like to talk to you a little bit more about uterine fibroids, and specifically I want to talk to you about the non-surgical management options for fibroids. So basically they're separated into two categories. The first is hormonal therapy, and the second is interventional radiology methods such as uterine artery embolization.

2. 0:24Hormonal therapies

   In terms of the hormonal therapies, I'm only going to talk about the FDA approved methods today, specifically the ones that are FDA approved in the United States, because there are treatments approved in Canada and Europe that aren't approved here yet for use for fibroids. So to begin with, the hormonal methods include something that we all know of as the birth control pill. So these are combination oral contraceptive pills.

3. 1:08

   And by this I mean, as I said, the birth control pill, but when I say combination, I mean that these pills have both estrogen and progesterone in them. And the way they help with women who have fibroids is that they thin out the uterine lining that's stimulated by the fibroids, and that causes all the extra bleeding, and this heavy bleeding tends to be the main symptom, one of the main symptoms that women complain of when they have fibroids.

4. 1:30

   So these pills, these estrogen progesterone pills, don't work by shrinking the fibroids. They work by thinning out the uterine lining that's stimulated by the fibroids. That is actually the cause of the heavy bleeding.

5. 1:53Progesterone-only methods

   The second option are progesterone only methods. Progesterone only methods also include a pill. We call it the mini pill, or progesterone only pill, but also there's a hormonal shot that has only progesterone. It's called Depo-Provera as the brand name, and there's an implant that women will have placed in their arm that's also progesterone only, and it's known as Nexplanon.

6. 2:16

   These three methods also work by thinning out the uterine lining, and again prevent, not prevent, but reduce the heavy bleeding that women can get from the fibroids.

7. 2:38

   Now these two methods that I mentioned that are helpful for heavy bleeding usually are not helpful long-term if the bleeding is truly from the fibroids, but it may buy the patient some time to reduce her bleeding and her main symptoms if they're due to fibroids and give her some time to think about other therapy options, but they're usually not a long-term remedy for patients, again, whose bleeding, heavy bleeding, is due to fibroids in particular.

8. 3:02

   And I'm clarifying that because some women may have heavy bleeding due to other hormonal imbalances or other medical problems, and sometimes they even have fibroids and these other problems. So we don't quite know what's causing the heavy bleeding in women sometimes until we do further examinations like ultrasounds and blood tests and such.

9. 3:23Progesterone IUD

   The third option is the progesterone IUD. Unlike the first two, this also helps by thinning out the uterine lining. The uterus can only be so big before we're allowed to put in this progesterone IUD.

10. 3:46

    In other words, if the uterus is very large with fibroids, generally we use about ten centimeter guideline in terms of the size of the uterus. But if it's larger than about ten centimeters, we usually don't want to use progesterone IUDs, because as the uterus continues to grow with the fibroids, sometimes the IUDs can get pulled in, kind of up into the uterus as it grows, and then it can be hard to pull out later.

11. 4:08

    And again, like the first two categories, this may just be a temporary remedy for women with fibroids and heavy bleeding, because this is not shrinking the fibroids, it's just reducing the amount of blood. So lastly we have something called Depo Lupron.

12. 4:30Depo Lupron

    And this is an injection that is a type of drug known as a GnRH agonist. And so basically what this does is it works in the central part of our brain and sends signals to our ovaries telling it to stop making estrogen and progesterone.

13. 4:53

    So as you can imagine, it actually puts women in a temporary menopausal state, and that can have side effects associated with it, such as hot flashes or night sweats or vaginal dryness, menopausal symptoms. And it also can cause bone loss. Now that bone loss is often reversible.

14. 5:16

    In other words, when you stop using the medication, women will gain much of that bone strength back, but not necessarily all of it. And for that reason it's only approved in the United States to be used for three to six months. Sometimes we use it longer, up to 12 months. And it does work well, actually, to shrink the fibroids and in that way to reduce the heavy bleeding that happens with the fibroids and the stimulation of that uterine lining.

15. 5:37

    But it can only be used temporarily. It's not a long-term solution for the fibroids. So most commonly we use this one in preparation for surgery. So let's say a woman has fibroids and we've decided to surgically remove them, but she's bleeding so heavily and becoming anemic from it that she is not a good surgical candidate. Then we'll use the shot, this injection, to reduce the volume and the amount of bleeding for a few months, let the woman build up her iron stores and reverse her anemia, so that it's then safe for us to take her to surgery.

16. 6:00

    The other purpose in using it might be to shrink the fibroids to make it more amenable to less invasive surgical methods such as, I'll talk about this in a future video, but hysteroscopy, a lot. Okay.

17. 6:23Uterine artery embolization

    And then the last category I mentioned, there's the hormonal therapies, and then the non-hormonal interventional radiology therapies. That last category is known as uterine artery embolization.

18. 6:43

    Now, write that out here. In short it's called UAE, uterine artery embolization. And this is a procedure by which a radiologist will place catheters in the femoral arteries, which are in the woman's groin, and they lead that catheter up to the uterine artery, which is the artery that supplies the uterus.

19. 7:07

    And they push pellets made of a substance called PVA, polyvinyl alcohol. There's different substances, similar substances in this category, but they're basically, think of them as little pellets that cut off the blood supply to the uterine arteries, and in that way the fibroids start shrinking. Now the whole uterus doesn't die because the uterus has other blood supply besides that from the uterine artery.

20. 7:30

    So even if we block off these particular uterine artery vessels, there's nothing blood supply that keeps the uterus alive, but the blockage of the main supply, the uterine artery vessels, will reduce the size of the uterus and the fibroids within it. So this is also not a procedure that's without complications.

21. 7:52

    Patients can have pelvic pain and other complications after uterine artery embolization, but it is an alternative to surgery, and this can definitely be investigated more with your doctor. If you ask more questions, I'm sure they'll be able to tell you more about that procedure. So basically this is the basic rundown of the non-surgical options for treating uterine fibroids.

22. 8:14

    As I always say, I can't cover everything in full detail in these short videos, but I hope it gives you a basic introduction to your options. So thanks for tuning in, and please don't forget to subscribe.