Uterine fibroids, those pesky but benign tumours that can cause discomfort, are often managed by adapting aspects of sufferer’s lifestyles, or occasionally surgical intervention. While surgery is sometimes unavoidable, and yoga may be great, hormone treatments offer a powerful and non-invasive solution to manage symptoms and improve daily life. Yet, despite their potential, hormone therapies are often unfairly stuck with a bad reputation, mainly thanks to myths and misinformation.
It’s time to clear the air and shine a spotlight on how these treatments can be beneficial for women with fibroids when used in the right amounts and under the right care.
Dispelling hormone therapy myths
One of the most pervasive myths surrounding hormone therapies is that they contribute to fibroid growth or increase their size because they often contain oestrogen and progesterone. Higher levels of these hormones do contribute to fibroid growth during the reproductive years, which is why fibroids shrink after menopause when these hormone levels drop[1]. Sounds solid, so where’s the myth? Well, while it’s true that oestrogen and progesterone can stimulate fibroid growth, hormone therapies aimed at treating fibroids generally work by reducing these hormone levels, not increasing them[2].
The next big myth isn’t really a myth – just a statistical misunderstanding. Hormone therapies are sometime completely avoided because of fear of negative side effects like venous thrombosis (the formation of blood clots in the veins). It is true women taking hormone therapy for menopause symptoms, contraception, or treatment of conditions like uterine fibroids are at greater risk for venous thrombosis[3]. Particularly those with additional risk factors such as obesity, smoking, immobility, or a family history of blood clots. However, physicians will assess individual risk factors like a history of clotting disorders or lifestyle factors before prescribing hormone therapy. Additionally, while hormone therapy can increase the relative risk, in absolute terms, the incidence remains relatively low for most women, and the benefits largely outweigh the risks.
So beyond the myths, what’s the real truth? Balance.
Hormone therapy is about balance. It’s true that too much oestrogen and progesterone can cause fibroids to grow, so adding these in when your body is already producing these can have negative side effects. However, not having ANY oestrogen or progesterone in your body comes with negative side effects of their own. Hot flushes, bone density concerns, decreased libido, vaginal dryness and mood swings are all some of the symptoms women with supressed hormones, or women going through menopause can experience[4].
As such, hormone treatments that work to reduce normal hormone levels during your reproductive years over the short-term, or by adding back just enough of these hormones, can shrink fibroids or minimize your fibroid symptoms, while also leaving you free of those pesky “no hormone symptoms” we’ve mentioned above. For menopausal women, hormone therapies can work by adding back just enough of the hormones your body no longer makes to relieve menopausal symptoms, without causing your fibroids to grow.
This delicate balance of “just enough but not too much” is exactly why it’s so important to discuss ANY hormone treatment – from birth control to the more specific ones – with your gynaecologist. Every woman, their fibroids and their hormones, will be different.
Most common types of hormone therapies for fibroids: Reproductive years
Great, so now that we’ve dispelled some of myths around hormone therapies, we can start to look into some of the more common ones used to treat fibroids or manage some of the hard to deal with symptoms.
The first on our list is the most common – the pill. While not specifically designed for fibroid treatment, birth control pills can help manage heavy bleeding associated with fibroids. It does this by regulating the menstrual cycle, stabilizing the endometrial lining and reducing hormonal fluctuations. By keeping hormone levels more consistent, birth control pills prevent the spikes in oestrogen that can contribute to heavy bleeding and excessive menstrual flow[5]. There are two different kinds of birth control pills that can be used here. Combined oral contraceptives (oestrogen and progestin) are commonly used to regulate periods and lighten menstrual flow. Progestin-only pills can also be effective in reducing heavy bleeding without the oestrogen component.
The next is progestin therapy which is available in various forms (pills, injections, intrauterine devices etc). Progestins are synthetic forms of progesterone, and as for the progestin-only pill mentioned above, can significantly reduce menstrual bleeding and provide pain relief.
Moving on to a real medical mouthful, we have Gonadotropin-releasing hormone (GnRH). Both GnRH agonists (turns receptors on) and antagonists (turn receptors off) are effective for reducing fibroid size and controlling symptoms. While they work through different mechanisms, both create a temporary low-oestrogen state that helps manage fibroids. However, their use is often limited to short-term treatment due to potential side effects.
GnRH agonists work by overstimulating the pituitary gland, which initially After this initial surge, continuous stimulation leads to the shutdown of hormone production, creating a state similar to menopause. This temporary suppression of oestrogen (and to a lesser extent, progesterone) causes fibroids to shrink, since fibroids rely on these hormones to grow[6].
GnRH antagonists work differently from agonists by immediately blocking GnRH receptors in the pituitary gland. This prevents the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and quickly lowers oestrogen and progesterone levels without the initial surge seen with GnRH agonists. This rapid suppression of oestrogen leads to faster fibroid shrinkage and relief of symptoms. Antagonists also help control heavy menstrual bleeding. They are effective for short-term use, typically up to 6 months, often as a preoperative treatment to make surgeries like myomectomy easier[7].
In summary, GnRH agonists and antagonists are used to treat conditions like fibroids by reducing the body’s natural production of oestrogen and progesterone. However, this suppression of hormones can lead to the significant side effects that we introduced during the start of this article, such as hot flashes, bone density loss, and mood swings. Thankfully, some newer treatments combine GnRH antagonists with add-back therapy . This involves giving small doses of oestrogen (sometimes combined with progesterone) to counteract the side effects of long-term hormone suppression. This gives patients the benefit of oestrogen suppression by reducing fibroid size without the more severe side effects that occur when you remove it altogether[8].
Hormones to treat fibroids at menopause and beyond
In reproductive years, hormonal therapies like GnRH agonists or antagonists as mentioned above are used to manage fibroid symptoms and shrink fibroids by suppressing your body’s ability to produce hormones. Post-menopause, women’s ovaries stop producing female hormones like oestrogen and progesterone naturally altogether.
The lack of these hormones can lead to fibroid shrinkage naturally, but unfortunately can also result in a host of unpleasant side effects. To counteract this HRT (Hormone Replacement Therapy) or progestin therapy are commonly used.
HRT that includes oestrogen can stimulate fibroid growth[9], so its usually prescribed with caution, however it is not completely off the table for women with fibroids. Here the focus may be on non-oestrogen therapies or including lower doses of oestrogen combined with progesterone, and usually only in cases where the woman has mild fibroid symptoms.
Progestin therapy can be prescribed for post-menopausal women who still experience bleeding from fibroids. Low-dose progestin therapy can help reduce symptoms without exacerbating fibroid growth[10].
Conclusion: With proper care, hormones are another weapon in your fibroid fight
As we’ve discussed in this article, when used correctly, hormone therapies can reduce some of the more aggravating symptoms of fibroids like heavy bleeding, or in some instances can even help to shrink them. Additionally, hormone therapies are not just reserved for women pre-menopause, but under the guidance of a qualified physician, can help to combat menopausal symptoms without resulting in fibroid growth. The key to managing fibroids is to look at treatment through a holistic lens – merging lifestyle changes, hormone therapies and other surgical and non-invasive treatment options to get the best results. As hormone therapies’ effectiveness is reliant on careful balance, always consult your doctor before embarking on any kind of treatment plan.
References
[1] Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health. 2014 Jan 29;6:95-114. doi: 10.2147/IJWH.S51083. PMID: 24511243; PMCID: PMC3914832. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914832/
[2] Stewart, E., Laughlin-Tommaso, S., Catherino, W. et al. Uterine fibroids. Nat Rev Dis Primers 2, 16043 (2016). https://doi.org/10.1038/nrdp.2016.43
[3] LaVasseur C, Neukam S, Kartika T, Samuelson Bannow B, Shatzel J, DeLoughery TG. Hormonal therapies and venous thrombosis: Considerations for prevention and management. Res Pract Thromb Haemost. 2022 Aug 23;6(6):e12763. doi: 10.1002/rth2.12763. PMID: 36032216; PMCID: PMC9399360. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9399360/
[4] https://www.emjreviews.com/flagship-journal/article/perimenopause-and-menopause-an-opportunity-to-engage-inform-and-empower-women-to-live-well-j190423/#:~:text=Perimenopause%20is%20defined%20as%20the,the%20official%20definition%20of%20menopause.&text=It%20tends%20to%20start%20between,lasts%20for%20about%207%20years.
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854898/
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854898/
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854898/
[8] Eduard Mension, Joaquim Calaf, Charles Chapron, Marie Madeleine Dolmans, Jacques Donnez, Louis Marcellin, Felice Petraglia, Silvia Vannuccini, Francisco Carmona, An update on the management of uterine fibroids: personalized medicine or guidelines? Journal of Endometriosis and Uterine Disorders, Volume 7, 2024, 100080, ISSN 2949-8384,
https://doi.org/10.1016/j.jeud.2024.100080.
https://www.sciencedirect.com/science/article/pii/S2949838424000227#bbib0265
[9] https://pubmed.ncbi.nlm.nih.gov/12270580/#:~:text=Clinically%2C%20at%20end%20of%20the,first%202%20years%20of%20use.
[10] Efficacy, Safety, and Tolerability of Low-Dose Hormone Therapy in Managing Menopausal Symptoms, Robert D. Langer, The Journal of the American Board of Family Medicine Sep 2009, 22 (5) 563-573; DOI: 10.3122/jabfm.2009.05.080134 https://www.jabfm.org/content/22/5/563
