GnRH ANTAGONIST

There are several options for the medical treatment of uterine fibroid. However, the definitive treatment of uterine fibroid has been surgical. This has evolved over the years to include other non-surgical forms of treatments. Your doctor will take you through the various treatment modalities and help you arrive at that which is suitable for you. Medical treatment of myoma involve the use of certain classes of non-hormonal or hormonal medication to treat fibroid. This is not a definitive treatment as it only helps to reduce the symptoms and size of the fibroid. When treatment is stopped, the fibroid grows back. Medical treatment is indicated in the following situations;

• For symptomatic relief
• As an alternative to surgery in women who are near menopause, the fibroid usually shrinks at menopause due to lack of the hormone estrogen to fuel it growth.
• Where postponement of surgery is temporary
• As a pre- operative adjunct to reduce the size before surgery
• Patient that are not suitable for surgery
• Patient preference

NON HORMONAL MEDICAL TREATMENT OF UTERINE FIBROID

The prostagladin synthetase inhibitor class of medication include; mefenamic acid, ibuprofen and naproxen. It is used to treat heavy menstrual bleeding and painful menses. It is use daily throughout the period of menses starting from the onset or prior to onset of menses because it reduces blood loss and pain. Its use is not advisable in people with peptic ulcer disease and chronic kidney failure. Some side effects of this class of medication include: Gastritis, peptic ulceration, kidney failure.

The antifibrinolytic class of medication such as tranexamic acid is indicated for heavy menstrual bleeding. It is administered during menstruation for 5days to reduce blood loss. Its use is not advisable with concurrent use of combine oral contraceptives, history or an intrinsic risk for thromboembolism or allergic reaction to the medication. Its side effects include: thromboembolic event, impaired color vision, hypersensitivity reaction, nausea, vomiting, diarrhoea, abdominal pain.

The aromatase inhibitor class of medication include; letrozole and anastrazole. It is indicated for symptomatic treatment of myoma, use daily for 3months. It reduces the size of fibroid and blood loss during menses. This class of medication can cause profound reduction in estrogen which lead to menopausal symptoms and bone loss. If used for up to 6months, hormonal replacement therapy will be given to prevent causing premature menopause.

HORMONAL MEDICAL TREATMENT OF FIBROID

The gonadotropin releasing hormone agonist(GNRH) class of medication include: Leuprolide acetate (Lupron), Goserelin (Zoladex), Triptorelin (relstar). These injectable medications are given monthly or 3monthly for 3 to 6months. When used for more than 6months, hormonal replacement therapy is recommended due to its side effects. They act by down regulating the pituitary and suppress ovarian function. They have the advantage of reducing menstrual blood loss and may cause complete cessation of menses, improvement of anemia, relief of pressure symptoms by reduction in size of the fibroid, reduction in blood loss during surgery by reduction in the myoma blood supply and may facilitate the use of minimal access surgery such as laparoscopic or hysteroscopic surgeries. The disadvantages of the use of GnRH agonist include: menopausal symptoms (Vasomotor symptoms, trabecular bone loss), ovarian hyperstimulation, high cost, regrowth of myomas on cessation of therapy, degeneration in some myomas causing difficulty in removal during surgery.

The gonadotropin releasing hormone antagonist class of medication include: Ganirelix and Centrorelix. They are daily injectable and act by causing immediate suppression of the pituitary and the ovaries. They do not have the initial stimulatory effect like the GnRH agonist. Their benefits are same as that of agonists but it onset of cessation of menses is rapid. Have similar side effects with GnRH agonist.

The progesterone antagonist class of medication such as Mifepristone is recommended for 3 -6months.  It is effective in reducing fibroid size and heavy menses; it may cause complete cessation of menses. The drawbacks with its use includes: vasomotor symptoms such as hot flushes and feeling of one’s heart beats called palpitation and endometrial hyperplasia which is the thickening of the inner lining of the womb.

The selective progesterone receptor modulator class of medication such as the ulipristal acetate has similar effects to mifepristone. It is given orally daily for 12weeks. It reduces bleeding and fibroid size. The drawback with its use is that it causes endometrial hyperplasia.

The progesterone class of medication which include: Noresthisterone acetate, Depo-Medroxyprogesterone acetate, or Medroxyprogesterone acetate. They reduce blood loss and are used during acute bleeding then tapered down when bleeding reduce. The Levonorgestrel-releasing Intrauterine System (LNG-IUS) is inserted into the womb. It reduces blood loss and uterine size however, it is not recommended when the uterine size is >12 weeks or there is distortion of uterine cavity and has limited use in patient who do not desire contraception. Their side effects include: muscle and joint pain, breast pain, headache.

The androgen class of medication such as danazol administer daily or gestrinone administer twice weekly reduce blood loss and fibroid size. They may cause cessation of menses. Their side effects include: hirsutism, oily skin, acne, weight gain, voice change. Their use is limited only for a period of 3–6 months.

Though not applicable to all patients medical treatment of fibroid may obviate the need for surgery and it complications.