Alternative Oral Agents in Prophylaxis and Therapy of Uterine Fibroids—An Up-to-Date Review

Abstract

Uterine fibroids (UFs) are the most common tumors of the female genital tract. The effect of UFs on the quality of life and the overall cost of treatment are significant issues worldwide. Tumor size and location are the two specific factors which influence the occurrence of symptoms, the need for, and method of, treatment (some tumors require surgery while some can be treated with selected drugs). Primary prevention and treatment of early UF disease are worthy goals that might have a great impact on health care systems. Several treatments and prophylactic methods can be used in this endeavor. This publication presents current data about lesser-known substances which may have a beneficial effect on the treatment or prophylaxis of UFs and can be administered orally, serving as an alternative to (or complement of) surgery or selective progesterone receptor modulators (SPRMs). Early prevention and treatment of UFs in women from high-risk groups should be our priority. Innovative forms of UF management are under intensive investigation and may be promising options in the near future. Many of them evaluated vitamin D, paricalcitol, epigallocatechin gallate (EGCG), elagolix, aromatase inhibitors (AIs), and cabergoline and deemed them to be safe and effective. The next step in such projects should be properly constructed randomized control trials (RCTs), carried out by successive phases.

Vitamin D and Uterine Fibroids—Review of the Literature and Novel Concepts

“…Overexpressed TGF-β induces ECM overproduction by stimulating the expression of type I collagen, proteoglycans, and other ECM compounds, what in turn results in abnormal ECM accumulation [ 101 , 103 , 110 ]. VDR activation by its ligand results in reduced inflammation and fibrosis [ 34 , 111 ]. Owing to the studies by Halder et al, it was possible to prove that a surprisingly beneficial effect in UF growth reduction can be obtained under the influence of vitamin D [ 98 , 104 ].…”

“…The least studied factors which affect the risk for UF occurrence are related to lifestyle, diet, nutrition, or place of residence. Especially nutrition and diet can be the gateway to effective prevention of UFs [ 34 , 123 , 124 ]. As the new guidelines from 2018 defined optimal concentration of vitamin D at 40–60 ng/mL ( Figure 1 ) [ 39 ], vitamin D supplementation and sunlight exposure can be the two main clues for UF prevention [ 125 ].…”

“…The origin of UFs is multifactorial and that is why there are no specific methods of prevention at present [ 34 , 35 ]. Numerous attempts have been made to create inexpensive, safe, and effective methods of prophylaxis but they are still in the early stages [ 34 , 35 ]. In light of this, vitamin D, which plays one of the major roles in UF biology, might be the answer [ 13 ].…”

“…Vitamin D deficiency is an important risk factor in the development process of UFs [ 6 , 7 , 8 , 9 , 41 ]. There are several ideas about the use of vitamin D in UF prevention or as a long-term treatment [ 13 , 34 , 42 ], but ongoing clinical trials in this area remain scarce.…”

The effect of high-intensity focused ultrasound guided by magnetic resonance therapy on obstetrical outcomes in patients with uterine fibroids – experiences from the main Polish center and a review of current data

“…Another topic to be discussed elsewhere covers several drugs with proven efficacy in the treatment of UFs, including ulipristal acetate (UPA), GnRH analogs [13,24] and others [25][26][27]. The disadvantages of available drugs registered in UF therapy are relatively high price, average efficacy and, often, difficult accessibility.…”