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Update of Conservative Systemic Treatment of Uterine Fibroids

  • Management of Uterine Fibroid (I Meinhold-Heerlein, Section Editor)
  • Published:
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An Erratum to this article was published on 10 August 2014

Abstract

Uterine fibroids are a common disease in women and lead to different symptoms, like pain and bleeding disorders. Aside from surgical treatment, there are many medical treatment options, which are presented in this article. Combined oral contraceptives and Levonorgestrel-releasing intrauterine systems are possible options for bleeding disorders that are a consequence of uterine fibroids. Gonadotropin-releasing hormone agonists and the new selective progesterone receptor modulator Ulipristal acetate can effectively reduce myoma mass and vaginal bleeding rate. Ulipristal acetate should especially be considered in symptomatic women, as it has only a few noteworthy side effects.

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References

  1. Kim JJ, Kurita T, Bulun SE. Progesterone action in endometrial cancer, endometriosis, uterine fibroids, and breast cancer. Endocr Rev. 2013;34(1):130–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Ishikawa H, Ishi K, Serna VA, Kakazu R, Bulun SE, Kurita T. Progesterone is essential for maintenance and growth of uterine leiomyoma. Endocrinology. 2010;151:2433–42.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012;85(1):35–43.

    PubMed  Google Scholar 

  4. Hoellen F, Griesinger G, Bohlmann MK. Therapeutic drugs in the treatment of symptomatic uterine fibroids. Expert Opin Pharmacother. 2013;14(15):2079–85.

    Article  CAS  PubMed  Google Scholar 

  5. Qin J, Yang T, Kong F, Zhou Q. Oral contraceptive use and uterine leiomyoma risk: a meta-analysis based on cohort and case–control studies. Arch Gynecol Obstet. 2013;288(1):139–48.

    Article  CAS  PubMed  Google Scholar 

  6. Wise LA, Palmer JR, Harlow BL, Spiegelman D, Stewart EA, Adams-Campbell LL, et al. Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study. Am J Epidemiol. 2004;159(2):113–23.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Wildemeersch D, Andrade A. Review of clinical experience with the frameless LNG-IUS for contraception and treatment of heavy menstrual bleeding. Gynecol Endocrinol. 2010;26(5):383–9.

    Article  CAS  PubMed  Google Scholar 

  8. Heikinheimo O, Gemzell-Danielsson K. Emerging indications for the levonorgestrel-releasing intrauterine system (LNG-IUS). Acta Obstet Gynecol Scand. 2012;91(1):3–9.

    Article  CAS  PubMed  Google Scholar 

  9. Zapata LB, Whiteman MK, Tepper NK, Jamieson DJ, Marchbanks PA, Curtis KM. Intrauterine device use among women with uterine fibroids: a systematic review. Contraception. 2010;82(1):41–55.

    Article  PubMed  Google Scholar 

  10. Sayed GH, Zakherah MS, El-Nashar SA, Shaaban MM. A randomized clinical trial of a levonorgestrel-releasing intrauterine system and a low-dose combined oral contraceptive for fibroid-related menorrhagia. Int J Gynaecol Obstet. 2011;112(2):126–30.

    CAS  PubMed  Google Scholar 

  11. Kriplani A, Awasthi D, Kulshrestha V, Agarwal N. Efficacy of the levonorgestrel-releasing intrauterine system in uterine leiomyoma. Int J Gynaecol Obstet. 2012;116(1):35–8.

    CAS  PubMed  Google Scholar 

  12. Jindabanjerd K, Taneepanichskul S. The use of levonorgestrel—IUD in the treatment of uterine myoma in Thai women. J Med Assoc Thail. 2006;89 Suppl 4:S147–51.

    Google Scholar 

  13. Beatty MN, Blumenthal PD. The levonorgestrel-releasing intrauterine system: safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009;5(3):561–74.

    CAS  PubMed Central  PubMed  Google Scholar 

  14. Cox M, Tripp J, Blacksell S. Clinical performance of the levonorgestrel intrauterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 5-year report. J Fam Plann Reprod Health Care. 2002;28(2):73–7.

    Article  PubMed  Google Scholar 

  15. Alton TM, Brock GN, Yang D, Wilking DA, Hertweck SP, Loveless MB. Retrospective review of intrauterine device in adolescent and young women. J Pediatr Adolesc Gynecol. 2012;25(3):195–200.

    Article  PubMed  Google Scholar 

  16. Baldaszti E, Wimmer-Puchinger B, Löschke K. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception. 2003;67(2):87–91.

    Article  CAS  PubMed  Google Scholar 

  17. Radesic B, Sharma A. Levonorgestrel-releasing intrauterine system for treating menstrual disorders: a patient satisfaction questionnaire. Aust N Z J Obstet Gynaecol. 2004;44(3):247–51.

    Article  PubMed  Google Scholar 

  18. Kim ML, Seong SJ. Clinical applications of levonorgestrel-releasing intrauterine system to gynecologic diseases. Obstet Gynecol Sci. 2013;56(2):67–75.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health. 2014;6:95–114.

    PubMed Central  PubMed  Google Scholar 

  20. Kiesel L, Runnebaum B. Gonadotropin–releasing–Hormon und Analoga, Physiologie und Pharmakologie. Gynakol Geburtshilfliche Rundsch. 1992;32:22–30.

    Article  CAS  PubMed  Google Scholar 

  21. Barbieri RL. Clinical applications of GnRH and its analogues. Trends Endocrinol Metab. 1992;3(1):30–4.

    Article  CAS  PubMed  Google Scholar 

  22. Minaguchi H, Wong JM, Snabes MC. Clinical use of nafarelin in the treatment of leiomyomas. A review of the literature. J Reprod Med. 2000;45(6):481–9.

    CAS  PubMed  Google Scholar 

  23. Friedman AJ, Barbieri RL, Doubilet PM, Fine C, Schiff I. A randomized, double-blind trial of a gonadotropin releasing-hormone agonist (leuprolide) with or without medroxyprogesterone acetate in the treatment of leiomyomata uteri. Fertil Steril. 1988;49(3):404–9.

    CAS  PubMed  Google Scholar 

  24. Kang J, YuWang D, XiaWang X. Yu J Up-regulation of apoptosis by gonadotrophin-releasing hormone agonist in cultures of endometrial cells from women with symptomatic myomas. Hum Reprod. 2010;25(9):2270–5.

    Article  CAS  PubMed  Google Scholar 

  25. Koskas M, Chabbert-Buffet N, Douvier S, Huchon C, Paganelli E, Derrien J. Role of medical treatment for symptomatic leiomyoma management in premenopausal women. J Gynecol Obstet Biol Reprod (Paris). 2011;40(8):858–74.

    Article  CAS  Google Scholar 

  26. Talaulikar VS, Manyonda IT. Ulipristal Acetate: a novel option for the medical management of symptomatic uterine fibroids. Adv Ther. 2012;29(8):655–63.

    Article  PubMed  Google Scholar 

  27. Campo S, Garcea N. Laparoscopic myomectomy in premenopausal women with and without preoperative treatment using gonadotrophin-releasing hormone analogues. Hum Reprod. 1999;14(1):44–8.

    Article  CAS  PubMed  Google Scholar 

  28. Vercellin P, Trespìdi L, Zaina B, Vicentini S, Stellato G, Crosignani PG. Gonadotropin-releasing hormone agonist treatment before abdominal myomectomy: a controlled trial. Fertil Steril. 2003;79(6):1390–5.

    Article  Google Scholar 

  29. Joffe H, White DP, Crawford SL, McCurnin KE, Economou N, Connors S, et al. Adverse effects of induced hot flashes on objectively recorded and subjectively reported sleep: results of a gonadotropin-releasing hormone agonist experimental protocol. Menopause. 2013;20(9):905–14.

    Article  PubMed  Google Scholar 

  30. Broit K. Drug-induced osteoporosis. Rev Prat. 2012;62(2):187–92.

    Google Scholar 

  31. Sagsveen M, Farmer JE, Prentice A, Breeze A. Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density. Cochrane Database Syst Rev. 2003;4, CD001297.

    PubMed  Google Scholar 

  32. Gainer EE, Ulmann A. Pharmacological properties of CDB(VA)-2914. Steroids. 2003;68:1005–11.

    Article  CAS  PubMed  Google Scholar 

  33. Levens ED, Potlog-Nahari C, Armstrong AY, Wesley R, Premkumar A, Blithe DL, et al. CDB-2914 for uterine leiomyomata treatment: a randomized controlled trial. Obstet Gynecol. 2008;111(5):1129–36.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. Donnez J, Tatarchuk TF, Bouchard P, Puscasiu L, Zakharenko NF, Ivanova T, et al. Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med. 2012;366(5):409–20.

    Article  CAS  PubMed  Google Scholar 

  35. Donnez J, Tomaszewski J, Vázquez F, Bouchard P, Lemieszczuk B, Baró F, et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med. 2012;366(5):421–32.

    Article  CAS  PubMed  Google Scholar 

  36. Spitz IM. Clinical utility of progesterone receptor modulators and their effect on the endometrium. Curr Opin Obstet Gynecol. 2009;21(4):318–24.

    Article  PubMed  Google Scholar 

  37. Donnez J, Vázquez F, Tomaszewski J, Nouri K, Bouchard P, Fauser BC, et al. Long-term treatment of uterine fibroids with ulipristal acetate. Fertil Steril. 2014;101(6):1565–73.

    Article  CAS  PubMed  Google Scholar 

  38. Presse-Information: Europäische Kommission erteilt Zulassung für ESMYA Typ II Variation.

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Conflict of Interest

Magdalena Maria Zalewski and Joseph Neulen declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Klinik für Gynäkologie und Geburtsmedizin, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

    Magdalena Maria Zalewski

  2. Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany

    Joseph Neulen

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  1. Magdalena Maria Zalewski
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Correspondence to Magdalena Maria Zalewski.

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Zalewski, M.M., Neulen, J. Update of Conservative Systemic Treatment of Uterine Fibroids. Curr Obstet Gynecol Rep 3, 191–195 (2014). https://doi.org/10.1007/s13669-014-0089-4

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  • DOI: https://doi.org/10.1007/s13669-014-0089-4

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