Drugs

Medications may be used as a first-line treatment for fibroids. The most effective are gonadotropin-releasing hormone (GnRH) agonists, which include Lupron, Synarel, and Zoladex. These suppress estrogen, creating a menopauselike state. Since fibroids are dependent on estrogen for their development and growth, lowering estrogen supply helps to shrink the size of fibroids and an enlarged uterus, which can reduce pelvic pressure and bleeding symptoms. Once the treatment is stopped, fibroids rapidly regrow, and the uterus expands once again.

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These medications can't be used indefinitely, since long-term use can significantly decrease bone density and increase the risk of osteoporosis. Because of this, GnRH agonists are used only for a short period in women nearing menopause, or for one month to three months prior to surgery in order to shrink fibroids in preparation for their removal.

A combination of GnRH agonists and low doses of estrogen and progesterone (to add back some of the suppressed hormones) is being studied to see if it can reduce bone loss and extend the time women can take the drugs. Preliminary data suggest that a combination protocol may be safe for up to two years if GnRH agonists are given alone first to allow the uterus to shrink and if the hormone dose is low (equivalent to hormone replacement therapy doses). Other medical therapies such as mifepristone, GnRH antagonists, and raloxifene are being investigated to determine how effectively they induce uterine shrinkage and stop menstrual periods.