Uterine fibroids is a complex disease that is still not fully understood by doctors or researchers. Fibroids vary greatly in terms of size, location, and symptoms, therefore, it is impossible to find the perfect therapy which could be used for every patient. There are many different methods that have been proven to be effective in reducing the size and number of fibroids. There are also many treatments aimed solely at improving symptoms. There are a few options which are capable of reducing both the size of fibroids themselves and the symptoms, and do not involve traditional invasive surgery, which most women prefer to avoid.
The need for early treatment of uterine fibroids
Research has shown that while 70-80% of women will develop uterine fibroids by the age of 50[^1] : only 25-50% are symptomatic [^2] and, until recently, most proven treatments either caused many side effects or they were invasive. Therefore, the majority of doctors choose a “wait and see” approach, which means they don’t recommend any treatment. Instead, they monitor fibroid progression and associated symptoms over time.
However, new studies also show that 50% of women express feelings of helplessness and lack of control over managing their uterine fibroids, even if they are asymptomatic.[^3] As a result, the “wait and see” approach is not ideal for most women.
Based on these new data, some physicians around the world have started treating women earlier in the disease process, recommending management with newly launched nutraceuticals, which have been proven to be effective in reducing fibroid volume (or at least halting the growth) and improving symptoms and quality of life.
Nutraceutical management of uterine fibroids
The latest research on uterine fibroid treatments has demonstrated the safety and effectiveness of alternative herbal and medicinal treatments, when recommended and monitored by a qualified healthcare professional.
In particular, clinical studies have shown the positive effects of epigallocatechin gallate (EGCG) and vitamin D in the management of uterine fibroids.
Epigallocatechin gallate (EGCG), found primarily in green tea extracts, has anti-inflammatory, antiproliferative (anti-growth), and antioxidant effects, which can help to reduce fibroid volume and growth, while improving symptoms.[^4] Similarly, vitamin D has a hormone-like activity, which can also stabilize or block uterine fibroid growth. Studies have demonstrated that the specific combination of EGCG (150mg), vitamin D (1,000 IU) and vitamin B6 (5mg) (Delphys, Lo.Li. Pharma International), assumed twice a day for four months, can have a significant impact, blocking the growth of fibroids and reducing associated symptoms, while improving the quality of life. There are no known side effects of this nutraceutical and it is considered completely safe.
Therefore, this type of nutraceutical is especially helpful if:
- You’ve been newly diagnosed with uterine fibroids and you are worried about UF growth or symptoms that could occur later on
- You have mild symptoms and you don’t want more aggressive pharmaceutical drug treatment or surgery
- You need maintenance treatment after surgery or after a period of treatment with a pharmaceutical drug
- You are seeking pregnancy
Of course, if the disease continues to progress, doctors may recommend more intense therapy with pharmaceutical drugs, which can be helpful as well.
Pharmaceutical management of uterine Fibroids
Most international obstetrical and gynecological societies recommend a “step-up” approach when treating uterine fibroids.[^5] Therefore, if nutraceutical management isn’t enough, the next best option may be medical management with pharmaceutical drugs. While most of these drugs aren’t specifically indicated to treat UF, many have been used historically, especially in the management of heavy menstrual bleeding.
The most prescribed pharmacological options are:
- Non-steroidal anti-inflammatory drugs (NSAIDs): While one of the least effective options, NSAIDs (like ibuprofen) are widely used due to their low cost and limited side effects. They are most effective at reducing heavy menstrual bleeding and pain when started a day or two before the onset of your period.
- Gonadotropin-releasing hormone (GnRH) agonists – The assumption of GnRH agonists reduces the production of gonadotropins and gonadal steroids, which produce the sex hormones estrogen and progesterone. This stops further fibroid growth and in some cases decreases fibroid volume. Because the treatment creates a menopause-like state, many women experience amenorrhea, which is the complete absence of the menstrual cycle. There are also associated side effects like hot flushes and the risk of bone mineral density loss. Older GnRH agonists, like leuprolide acetate, need to be injected intramuscularly and should only be used for a maximum of 6 months. Newer versions, like elagolix, relugolix, and linzagolix, can be taken orally for up to two years. In any case, women need to consider using “hormonal add-back therapy”, which means replacing the lost hormones due to the treatment itself, along with the GnRH agonist to reduce the risk of serious side effects.
- Hormonal contraception – The most common hormonal contraceptive treatment for UFs is progesterone-only, which is aimed at controlling heavy menstrual bleeding. This includes oral progestins (“the pill”) and intra-uterine devices (IUDs). Combined hormonal contraceptives can come in the form of pills, transdermal patches, or vaginal rings, and have a similar effect as the progesterone-only options. While these medications are effective in reducing blood loss, they don’t have any effect on the fibroids themselves.
- Tranexamic acid– The assumption of this non-hormonal medication (like Lysteda®) promotes blood clot formation, which therefore leads to a reduction in menstrual blood flow and related symptoms. This treatment can also be also used to minimize the bleeding associated with myomectomy surgery. It can be taken during the menstrual cycle for up to 5 days per month.
- Aromatase inhibitors –– While there is limited evidence to support their use, aromatase inhibitors such as letrozole and anatrozole may be helpful in reducing both the fibroid size and associated symptoms. They work by blocking the conversion of androgens (male sex hormones) to estrogens (female sex hormones), which results in a thinning of inner lining of the uterus and therefore reduced menstrual bleeding.
Final thoughts on nonsurgical treatment of uterine fibroids
As stated previously, most doctors and international associations recommend a “step-up” approach to the management of uterine fibroids. Therefore, you can work with your doctor to start treatment early on in the disease –– perhaps with a safe nutraceutical product –– with the goal of avoiding or delaying more aggressive or invasive treatments like pharmaceutical therapy or surgical interventions. And while your search for the right treatment can be a difficult journey, know that you will always receive great support from the I Don’t Wait community, who is here to help you find the right option for your unique circumstance.
[^1]: SOURCE: Baird D D, et al. Am J Obstet Gynecol. 2003.
[^2]: SOURCE: Buttram VC Jr, Reiter RC. Fertil Steril. 1981.
[^3]: SOURCES: Baird D D, et al. Am J Obstet Gynecol. 2003. Divakar H. Best Practices and Research in Clin Obst and Gyno. 2008.
[^4]: SOURCE: American College of Obstetrics and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008.