Role of Medical Management for Uterine Leiomyomas

The Effect of Uterine Fibroids on Infertility: A Systematic Review

“…126 These medications work by decreasing estrogen-dependent fibroid growth through downregulation of GnRH receptors in the pituitary, which decreases follicle-stimulating hormone and luteinizing hormone release, decreasing estrogen availability. 127 However, GnRH agonists have significant side effects, which include medically induced menopause, which can lead to significant hot flashes, vaginal dryness, and osteoporotic effects in bone. 128 In addition, fibroids begin to increase in size approximately 1 month after cessation of use, limiting their usefulness in the treatment of fibroid-associated infertility.…”

“…Studies have shown that progesterone is implicated in the growth of leiomyomas but not in normal myometrial cells, and that SPRMs can selectively decrease fibroid growth and cause apoptosis. 127,131 UPA decreases vascular endothelial growth factor (VEGF) and Bcl-2 expression and increases caspase-3 expression, leading to impaired vascularization, cell growth, and proliferation in fibroids. 131 Research has demonstrated that UPA significantly reduces fibroid size and can reduce the morbidity of surgery or potentially eliminate the need for surgery.…”

“…135,136 This medication class works by inhibiting aromatase, a cytochrome p450 enzyme, which blocks the conversion of androgens to estrogens. 127 Aromatase inhibitors appear to be as or more effective than GnRH agonists at reducing fibroid volume but have significantly fewer adverse effects when used short term. 137 In one randomized control trial, an aromatase inhibitor was able to decrease the total fibroid volume by 45.6%, compared with the GnRH agonist which decreased the volume by 33.2%.…”

“…137 Aromatase appears to be prevalent within fibroid tissue but not myometrium, allowing these medications to target myomas specifically. 127 One retrospective study revealed that aromatase is three times higher in fibroids than in normal myometrium. 138 Aromatase inhibitors may also work to decrease the difficulty of fibroid surgery, leading to improved fertility outcomes.…”

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

“…The disadvantages of available drugs registered in UF therapy are relatively high price, average efficacy and, often, difficult accessibility. None of the available drugs may also be used to prevent the formation of those tumors [21,28]. To date, none of the available hormonally active drugs has been classified for long-term treatment due to side effects accompanying such therapies [19,24,29].…”