Current and future treatment options for uterine fibroids

Uterine fibroids — benign growths of the uterus — affect up to 80 percent of women by the age of 50. While many women will never show symptoms and will not require treatment, others experience symptoms, both mild and severe, and may require some level of care.

Symptoms of uterine fibroids include heavy and painful periods; pelvic pressure; pain in the lower back; and discomfort during intercourse. Some women also experience fertility problems including infertility, miscarriages and early labor. Fortunately, women with fibroids have many treatment options.

"Fibroid treatment options include personalized symptom management — meaning, no treatment if a woman is without symptoms — or medication, surgery and uterine artery embolization if needed," says Dr. Craig Saffer, medical director of minimally invasive surgery at Sharp Mary Birch Hospital for Women & Newborns.

Medication
Medications currently used for the short-term relief of fibroid-related symptoms include non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen; birth control pills; and gonadotropin-releasing hormone antagonists, which stop the menstrual cycle and can shrink fibroids. According to Dr. Saffer, very exciting new oral drugs are currently awaiting authorization.

"My research group, West Coast Medical Research, is pending approval from FDA for clinical trials on two uterine fibroid oral treatments," he says. "Gonadotropin-releasing hormone antagonists and progesterone receptor modulators, which are already used outside of the U.S., both cause a rapid decrease in menstrual flow along with some shrinkage of fibroids."

Dr. Saffer also says that FDA has approved a similar, exciting oral medication containing elagolix for the treatment of symptomatic fibroids. He adds that studies of women with symptomatic fibroids using this drug seem to have had good results.

Surgery
Surgery is often used to treat moderate or severe uterine fibroids. A woman's desire to have a future pregnancy; the size and location of the fibroids; and the number of fibroids present are considered when determining the type of surgery performed.

"A myomectomy, or surgical removal of fibroids, is the gold standard if you want to retain child-bearing potential," says Dr. Saffer. "We most commonly do this with minimal invasiveness — either laparoscopically through small incisions in the abdomen, often with robotic system assistance, or hysteroscopically, when a small camera and instruments are inserted through the cervix. Both methods offer excellent results with less pain and scarring, a short hospital stay, and a rapid return to normal activities."

According to Dr. Saffer, a hysterectomy — the partial or complete removal of the uterus — can also be performed with minimal invasiveness. This surgical method is often recommended if the fibroids are numerous or large; there is very heavy monthly bleeding; and future fertility is not desired. A hysterectomy cannot be reversed, so pregnancy will not be possible after the procedure.

Uterine Artery Embolization (UAE)
UAE is a minimally invasive, cost-effective treatment for uterine fibroids. It is an image-guided procedure performed by interventional radiologists who use a catheter to deliver small particles to block the uterine arteries. UAE preserves the uterus, works well for symptom relief and causes a fibroid shrinkage of between 30 to 50 percent; however, it does not completely remove the fibroids.

"UAE is performed by excellent interventional radiologists at Sharp," Dr. Saffer says. "The majority of blood supply to the uterus is through the uterine arteries. This treatment option for women living with fibroid symptoms essentially blocks the flow of blood to the uterus and fibroids. It is a good alternative for patients who have no desire for future pregnancy and who would like to avoid surgery."

Dr. Saffer advises women to talk with their doctor if they are experiencing any of the symptoms of uterine fibroids. "With guidance from your gynecologist, you can determine if you're an appropriate candidate for one or more of the many available treatments," he says.