Medical therapy for fibroids: An overview

Uterine fibroids are the most common benign tumours in women of reproductive age group and are a cause of significant healthcare burden. Although surgical treatments have been the traditional gold standard for symptomatic uterine fibroids, several medical therapeutic approaches have been used to achieve symptom suppression in women who wish to preserve their uterus or are at elevated risk of complications during surgery. Medical therapies used for uterine fibroids include tranexamic acid, NSAIDs, contraceptive steroids, progesterone coil, GnRH analogues, aromatase inhibitors, SERMs and progesterone receptor modulators. The levonorgestrel containing intrauterine system reduces menstrual blood loss associated with fibroids, but drawbacks include the possibility of device expulsion and fitting difficulties. The use of GnRH agonists for 3-4 months prior to fibroid surgery can achieve reduction in uterine volume and fibroid size. They are beneficial in the correction of preoperative iron deficiency anaemia, if present, and reduce intra-operative blood loss. Although medical treatments provide effective symptom relief, women resorting to these therapies should be made aware of the high rates of future re-intervention. It is important for clinicians to recognise limitations of these therapies and that appropriate patient selection is of utmost importance.