Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Patients may be given nonsteroidal anti-inflammatory drugs, oral contraceptives (birth control pills), gonadotropin releasing hormone agonists, or RU-486.
Nonsteroidal anti-inflammatory agents, such as ibuprofen (Advil is one example), have been shown to relieve pelvic pain associated with fibroids.
Oral contraceptive pills are also commonly used in women with fibroids. Although the hormones (including estrogen) in such birth control pills may increase the size of the fibroid, they often decrease perceived menstrual blood flow and help with pelvic pain.
Gonadotropin releasing hormone (GnRH) agonists are
medications that act on the pituitary gland to decrease estrogen produced by
the body. A decrease in estrogen causes fibroids to decrease in size. This
type of medication often is used prior to surgery to shrink the fibroid, to
decrease the amount of blood loss during surgery, or to improve preoperative blood count. The size of the fibroid can be reduced by 50% in
months with of this type of therapy. But fibroids can regrow once treatment is stopped. Long-term therapy with these medications is limited by the side effects of low estrogen (much like menopause caused by drugs), which include decreased bone density,
osteoporosis, hot flashes, and vaginal dryness.
The antihormonal drug RU-486 (mifepristone) has also been shown to reduce fibroid
size by about half. This drug has also been shown to reduce pelvic pain, bladder pressure, and
lower back pain. Low doses of this drug may reduce the size of fibroids in preparation for surgery to remove them. It may also help
some patients avoid surgery entirely by shrinking the fibroids and the problems they are causing. Side effects related to low estrogen, seen with GnRH analogs, may be less common. RU-486 can induce miscarriage, so this medication should be used with caution if
a woman is trying to conceive.
The drug danazol (Danocrine) has been used to reduce bleeding in women with fibroids, since this drug causes menstruation to cease, but it does not shrink the size of fibroids. Danazol is an androgenic (male) hormonal drug that can cause serious side effects including weight gain, muscle cramps, decreased breast size, acne, hirsutism (inappropriate hair growth), oily skin, mood changes, depression,
decreased high density lipoprotein (HDL or 'good cholesterol') levels, and
increased liver enzyme levels.
Another new drug may eventually be useful in treating some uterine fibroids. It is a progesterone receptor modulator named EllaOne. It is used in Europe as an emergency contraception drug but was found to shrink fibroids and reduce bleeding associate with fibroids. The drug is likely to be considered for FDA approval for use in the U.S. in the near future.