There are several options for treating fibroids medically. Birth control pills, progesterones such as Provera, the Mirena IUD, and Lupron are all in this category. These will not cure the fibroids or make them go away but they may be able to manage the symptoms to improve quality of life.
Birth control pills are a combination of estrogen and progesterone. One of the main side effects of birth control pills is to make periods lighter and less crampy. This is exactly the benefit that is needed to manage fibroids. Birth control pills taken in the normal way will not stop the periods completely but can make them much more manageable. Birth control pills can also be used in what is called a continuous manner, this means not using the placebo pills bit rather taking an active pill every day. For many women this can stop the periods completely. If the periods are heavy and painful from fibroids, stopping them completely with birth control pills may be an excellent solution. Birth control pills also have the added benefit of providing contraception. For women with symptomatic fibroids that desire contraception, birth control pills can serve a dual role.
Progesterones can be used alone to treat the symptoms of fibroids. Provera is the most commonly prescribed progesterone, but there are other options as well. Progesterones can be used for 10-14 days each month to make periods lighter and less painful. The advantage of this method is that there is no exposure to estrogens and therefore less side effects and risks. The disadvantage is this is less likely to achieve results as much as birth control pills. This method also does not provide contraception.
The Mirena IUD is a device that is placed inside the uterus by the doctor in the office. It lasts for 5 years and can be very effective for decreasing the menses. It does provide contraception as well. The IUD can be painful during insertion but the pain generally only lasts a couple of minutes. The hormone exposure is very minimal compared to the above methods. In women with fibroids there is a greater risk that the IUD will be expelled from the uterus.
Lupron is a monthly injection that puts the woman into temporary menopause while she is receiving the injections. It is typically used for 3 months in women with fibroids. It can be very effective in reducing the size of the fibroids but this reduction is temporary. Lupron has a lot of side effects. All of the symptoms of menopause are possible and likely. This includes hot flashes, night sweats, mood swings, and headaches. There are limited situations where Lupron might be considered. In a woman desiring pregnancy that is having fertility issues due to the fibroids this is an option to use instead of myomectomy (surgical removal of the fibroids). The idea is to shrink the fibroids with the Lupron and then to try to achieve pregnancy before they can grow back. Another situation in which Lupron ay be used is to reduce the size of the uterus to prepare for surgery. Lupron can be given for 3 months making the uterus smaller. Surgery can then be performed and if the uterus becomes small enough simple surgical procedures such as vaginal hysterectomy may be possible.