Fibroid Medications: GnRH Agonists
When it comes to treating uterine fibroids, informed decisions are the best decisions. Therefore it is important to take a look at all of the fibroid treatments that are available. Whether it’s surgery, UFE, or medication, you and your doctor can find the one that’s best for you.
The first mode of treatment we are going to look at is a type of medication called Gonadotropin-releasing hormone (GnRH) agonists.
Gonadotropin-releasing hormone (GnRH) agonists are one of the most common medications that are used to treat uterine fibroids. These medications can be taken via a nasal spray or an injection.
GnRH agonists work by decreasing estrogen and progesterone levels in the body. The decrease in these hormones causes a temporary menopause-like state which reduces the size of the fibroids and the size of the uterus. It also inhibits menstruation,
thus enabling women with bleeding-induced anemia, to increase their stores of iron. These medications can also improve fibroid-related symptoms such as frequent urination and constipation.
GnRH agonists are sometimes prescribed in order to help shrink fibroids prior to surgery.
The most commonly prescribed Gonadotropin-releasing hormone (GnRH) agonists are Lupron, Synarel, and Zoladex. Though these medications improve symptoms and shrink fibroids, they do not eliminate them completely. Furthermore, it is estimated that 40% of women taking these medications experience the side effects of hot flashes and other symptoms of menopause, which can be problematic. Other common side effects are:
– mood changes
– increased sweating
– muscle stiffness
– vaginal dryness
The most concerning side effect of GnRH therapy is osteoporosis.
Osteoporosis is a disease that weakens the bones, thus putting them at a greater risk for sudden and unexpected bone fractures. Since estrogens play a central role in the homeostasis of the skeleton, estrogen deficiency seems to be primarily responsible for the adverse skeletal effects of GnRH agonists. As a result of the estrogen decrease caused by GnRH therapy, bone turnover can increase while bone mineral density can decrease, thereby increasing the risk of fractures.
The side effect of osteoporosis is typically associated with the long-term use of GnRH agonists. However, regardless of the amount of time, stopping this form of treatment can lead to rapid regrowth of the fibroids and the uterine size. Therefore, typically the best use of these medications is usually a short-term administration of them, as a preoperative course in order to shrink the uterus and fibroids in preparation for surgery.
GnRH agonists are not the only medication that is used in the treatment of uterine fibroids. Depending on the severity of the fibroid symptoms, sometimes progesterone-containing birth control can be effective. Next week, we will take a look at this form of treatment.
