The history of medical treatment of uterine fibroids, up until recently, was unfortunately lacking variety. The options were limited to either living with it — both the fibroids and the accompanying symptoms, or to have a hysterectomy. A hysterectomy not only eliminates fertility entirely, but it’s also major surgery; recovery time is between six and eight weeks, which requires missed time at work and limited availability to care for children or other family members.
The “new” option was the myomectomy, that is removal of the myomas (fibroids) while leaving the uterus intact, thus preserving fertility. While the first documented myomectomy is reported to have been performed in 1845, this option didn’t become widely available until the 1990’s. Recovery time for a myomectomy is somewhat less than that of a hysterectomy – between four and six weeks.
Next came uterine artery embolisation (UAE) which is more minimally invasive than either of the options previously mentioned.
In uterine artery embolization — also called uterine fibroid embolization — a doctor uses a slender, flexible tube (catheter) to inject small particles (embolic agents) into the uterine arteries, which supply blood to your fibroids and uterus. The goal is to block the fibroid blood vessels, starving the fibroids and causing them to shrink and die.
Recovery time with UAE is fairly quick, with women able to return to work within a week. Still, heavy lifting and exercise need to wait four weeks.
Unfortunately, none of these removal methods guaranteed the end of fibroids. In fact, between 10-50 women out of 100 experience a re-appearance of fibroids at some point. So with surgery carrying a risk and no guarantee against a reappearance, there was still great demand for a non-invasive method of treatment.
New options available today
At long last, we are seeing some pharmaceutical options appearing on the market. A new class of GnRH antagonist (hormonal) medications have recently been approved and have been introduced to the market. This alphabet soup drug classification stands for an antagonist of the gonadotropin-releasing hormone receptor and include Elagolix, available in the US and Relugolix, available in Europe. GnRH antagonists in general began to appear on the market in 1999 and are used to assist in treatment of a number of hormonally-affected issues, including infertility.
When researchers work hard and invest in developing non-invasive treatments with as few side effects as possible, we view this as an immensely positive development. This step has been reached through women speaking out, demanding better options and raising awareness.
Additional options are coming
Additional studies and developments are also underway. For example, work is being done to discover why women of African descent are diagnosed with fibroids at significantly higher percentages than the general female population. Especially disturbing in connection to this population is that they tend to develop fibroids earlier in life, reporting more tumors and more difficult symptoms, resulting in higher rates of surgery and hospitalization than their European-descended counterparts. As fibroids generally disappear at menopause, development of growths earlier in life translates to more difficult years enduring symptoms that include heavy menstrual bleeding, bloating, chronic pain, difficulty with urination and constipation as well asu for some, issues of infertility.
There is also a promising study underway to discover biological predictors of treatment outcomes, that is using genetic information to determine both the causes of fibroids and the most effective treatments to minimize the growths and their symptoms. This is promising in that through the knowledge that one may be more susceptible to developing fibroids, earlier diagnosis and treatment is made possible. When growths are smaller, more treatment options are available, among them less invasive options.
Additionally, there is research currently being conducted specifically pinpointing the issue of heavy menstrual bleeding in women with uterine fibroids. This specific symptom is especially problematic, as it can reach a point causing even extreme anemia, which is a dangerous condition. Copious bleeding can also make continuing work in a traditional office environment somewhere between challenging and impossible, affecting a woman’s life in many ways.
Women Talking Fibroids salutes the many researchers involved in these projects, as well as their financial backers, investing immense thought, effort, expertise and resources into improving the lives of women worldwide. Keep it up and we look forward to seeing and benefiting from the results of their efforts.