important menopause information
Many women know that fibroids can make life miserable. Heavy bleeding and prolonged bleeding, pelvic pain and cramps, bladder pressure, anemia, and an abdominal mass can all result in making the menstrual cycle a dreaded monthly event.
The traditional treatment for uterine fibroids is surgery. Hundreds of thousands of hysterectomies are done per year, and the majority are for fibroids. We need to find alternative treatment modalities that are non-surgical, low risk, and improve quality of life for women.
Here are some of the topics discussed today at the North American Menopause Society Translational Science Symposium in San Diego.
If fibroids are not symptomatic, they do not need to be treated, unless you want to get pregnant.
Whether fibroids should be removed prior to attempting pregnancy depends on location and size. Fibroids do increase some adverse pregnancy outcomes including premature deliveries and miscarriage. It is complicated, but the message is that all fibroids do not have to be removed prior to attempting pregnancy. Before surgery is done for fertility reasons, other infertility factors should be considered.
African-American women have more fibroids and develop them younger than Caucasian women. Some studies show that fibroids grown from uterine muscle stem cells that may have a genetic mutation, and perhaps a hormonal event in utero, like DES, may be causative . African-Americans may have more hormonal sensitivity, and have been found to have more aggressive breast and uterine cancers. Learning about how to turn off this genetic change is an important area of research.
Physicians always believed that estrogen was the cause of fibroid growth, but it is now known that progesterone is also very important in fibroid development. That is why researchers are looking at drugs that can block progesterone receptors in the fibroids. SPERMS, selective progesterone receptor modulators, are being developed that can block fibroid growth.
So how do we manage fibroids in the peri-menopause. We know that fibroids are rarely a problem after menopause, as they shrink with the lower levels of estrogen and progesterone after menopause. But, those years prior to menopause can be very difficult, and there are many options
Birth control pills are very effective in reducing blood flow, without making the fibroids grow significantly. NSAID’s and can reduce bleeding about 20-40%. Tranexamic acid can reduce bleeding about 40%. A progesterone containing IUD can significantly reduce bleeding, but fibroids can increase the expulsion rate. Lupron, which creates a temporary menopause with lower estrogen, is very effective in reducing fibroid size. Fibroids in the cavity of the uterus, which are the ones that cause the most bleeding, can be removed by hysteroscopic resection. Endometrial ablation can significantly reduce bleeding. Uterine artery ablation is also
What is on the horizon?
In Europe, a procedure that uses ultrasound directed ablation of the fibroids, administered via laparoscopy is being developed. In Canada and the EU, a selective progesterone receptor modulator, ulipristal, is used that can stop heaving bleeding episodes. The FDA has failed to approve this in the US yet, due to concerns about side effects. It is expected that as more data is accumulated, this drug will be approved for use in the US. There are many other drugs in this category that are being developed.
Here are some other medications or supplements that show promise and are currently being studied that may reduce the size of fibroids: simvastatin, aromatase inhibitors, green tea extract,
retinoid acid, Vitamin D, and berberine (a Chinese herb).
The research on how fibroids grow and change is very interesting on a molecular level.
We look forward to additional treatments that will reduce surgery in the near future, while making quality of life much better for women with fibroids.
Marilyn Jerome, MD
2018 Wolf Utian Translational Science Symposium, Tuesday, October 2, 2018
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