Uterine fibroids, non-cancerous tumors that grow on the uterus, are common in women of child-bearing age. In fact, they may affect up to 25% of all women, and between 30% and 40% or those in the perimenopausal age range [as young as 30 and to age 44], according to E.A. Stewart in the 2015 article “Uterine Fibroids,” in the New England Journal of Medicine.
Many times, the fibroids have no symptoms at all. However, as they grow, they can put pressure on your organs, causing pain and other symptoms. Sometimes, they can make it difficult for you to get pregnant or increase your risk for pregnancy complications causing preterm birth.
Women of color are up to three times more likely than white women to experience fibroids. They also report more intense symptoms. Of those women who report heavy menstrual bleeding, nearly two-thirds experience iron-deficiency anemia, which can cause fatigue, nausea and depression.
There are three types of fibroids.
- Subserosal: in the walls of the uterus poking outward
- Intramural: inside the walls of the uterus
- Submucosal: in the walls of the uterus poking into the center of the uterus
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Diagnosis and Causes of Uterine Fibroids
Many women with uterine fibroids don’t feel any symptoms before they’re discovered by an OB/GYN. Your doctor might feel them during a pelvic exam or see them in a sonogram or even find them during a cesarean section.
Scientists don’t know what causes fibroids, but you may be able to reduce your risk of fibroids by maintaining a healthy body weight.
Symptoms of Uterine Fibroids
- Prolonged menstruation or heavy bleeding
- Pain (often in the pelvis, back or legs)
- Pressure on the pelvis
- Frequent urination
- Constipation
- Increased risk of pregnancy complications, such as preterm birth
Uterine Fibroids Treatments & Side Effects
Not everyone with fibroids requires treatment. If your fibroids aren’t causing you problems, you and your doctor may decide to monitor them to see if they grow before prescribing medicines or surgery.
Surgical Options
There are numerous surgical options to shrink or remove fibroids, such as hysterectomies, laparoscopic surgeries, or newer options like noninvasive focused ultrasound surgery. But not everyone wants surgery or is a good candidate for a procedure, explains Cheruba Prabakar, MD, a gynecologist in Oakland, Calif. Medicines are “also good for patients who are poor surgical candidates—so patients who have had multiple previous surgeries, a lot of scar tissue,”she says. If you do discuss surgery, be sure to ask your doctor about the surgical technique. Some may use older surgical equipment like morcellators which are no longer recommended in most circumstances.
Oral Medications to Lighten Menstrual Bleeding
Most medications aim to lighten the heavy bleeding associated with uterine fibroids, which can lead to deficiencies such as anemia, though non-steroidal anti-inflammatory drugs (NSAIDS) may also be used to manage pain. Not all of these medications can shrink fibroids or slow their growth, so you may use medications for a while. If the fibroids grow quickly, you may still opt for surgery later. “When it comes to fibroid treatment or bleeding, there [are] very few options out there,” says Prabakar. “One of the most common ones is birth control. But it’s just genuinely for heavy bleeding. There are very few medications that we’ve actually studied for just fibroids.”
Birth Control
Even though the birth control pills contain estrogen, they work by preventing ovulation, which can lead to lighter periods and fewer symptoms. However, in some cases hormonal contraceptives can actually worsen fibroids.
- Spotting
- Fluid retention
- Blood clotting
- Mood changes
- Increased risk of heart attack or stroke (especially for those who smoke or are over 35)
- Breast tenderness
Lupron (GnRH agonists)
How It Works: These drugs block the hormone estrogen. They’re also used to treat endometriosis and delay puberty. The drug stops menstruation and can sometimes shrink fibroids.
Side Effects: Since the drug stops menstruation, the side effects often mimic menopause symptoms. You might be prescribed hormone replacement therapy (HRT) to lessen the side effects, which include:
- Hot flashes
- Decreased libido
- Mood changes
- Headaches
- Reduced bone density
Patient Experience: When oral contraceptives weren’t sufficient to treat her endometriosis, Jillian Amodio’s doctor prescribed the GnRH agonist. Taking it, she says, was “the worst decision” she’s ever made. She had to do physical therapy after the injection hit a nerve and led to sciatica. Instead of improving the mood swings she experienced on contraceptive pills, she says this treatment “threw the mood swings into overdrive.” To mitigate the risk of fractures due to reduced bone density, Amodio was told to take calcium supplements while she was on the GnRH agonist. She believes the supplements were likely responsible for the eight kidney stones she formed while using the drug.
Oriahnn (elagolix with estradiol/norethindrone acetate)
How It Works: Oriahnn is a newer drug, approved by the Food and Drug Administration (FDA) in May 2020. It works the same way as GnRH agonists do, by blocking estrogen. However, it’s thought to be better tolerated because it already contains the supplemental hormones like those you might be prescribed to treat side effects of GnRH agonists. However, having it already incorporated into the combination treatment may make it harder to customize a dose for you. While the drug lightens heavy bleeding, the addition of the supplemental hormones seems to reduce its ability to shrink fibroids.
Side Effects: Like GnRH agonists, the drug can raise your risk of bone loss and cause menopause-like symptoms, such as hot flashes. It’s not known whether stopping the drug reverses bone loss. It can also cause hair loss and raise your risk for heart attacks.
Because it hasn’t been studied for long-term use, you shouldn’t take it for more than two years.
“In clinical practice, I really haven’t had patients complain about hot flashes on this medication,” Prabakar says. She adds that the loss of bone density isn’t a big concern as long as it isn’t taken for more than two years and there’s no a history of chronic steroid use or of osteoporosis that puts a patient at risk for bone loss.
Myfembree (relugolix with estradiol/norethindrone acetate)
How It Works: The drug, which was approved by the FDA in May 2021, is also a combination of a GnRH agonist and supplemental hormones to reduce side effects.
Side Effects: The drug comes with a black box warning regarding an increased risk of blood clots and strokes. As with GNrH drugs, menopause-like symptoms are common side effects and the drug may cause bone loss.
Lysteda (tranexamic acid oral)
How It Works: Lysteda is a non hormonal drug you take only during your period, rather than every day. It works by breaking down the blood clots often associated with heavy menstrual bleeding.
Side Effects:
- Blurred vision
- Headaches
- Sinus problems
- Pain in your back, abdomen or joints
- Anemia
- Fatigue
- Abnormal bleeding or bruising
Patient Experience: Emma Gordon says, “I couldn’t cope with the pain that comes with prolonged bleeding.” Her doctor prescribed her Lysteda (tranexamic acid oral), which she said helped at first. Over time, though, she became weak and started fainting. The symptoms may have been side effects of the fibroid drug, so her doctor told her to stop taking it. She eventually required surgery to manage her fibroids.
Iron Supplements
How They Work: If you have heavy menstrual bleeding that causes iron-deficiency anemia, your doctor may suggest you take over-the-counter iron supplements. It can take up to three to six months to replenish your body’s iron stores. If heavy bleeding continues, you may need the supplements long term.
Side Effects: Most often, iron supplements can cause nausea or upset stomach. In extreme cases, large doses can lead to a deadly outcome, iron toxicity.
Questions to Ask Your Prescriber
If your healthcare provider suggests that you take one of the drugs mentioned above to treat fibroids, here are questions to ask:
- What is my risk for bone loss?
- How long can I take this?
- Will I need surgery eventually?
- Will this affect my fertility?
- Does my medical history suggest I’m at heightened risk for side effects like blood clots or bone loss?
- What specific side effects should I watch out for?
- What will happen if I don’t take this medication?
- Will my symptoms likely get worse?
