Uterine fibroids are noncancerous growths that occur in the uterus. They develop from single smooth muscle cells and affect 20-40% of reproductive aged women. African American women and overweight or obese women are at higher risk. Fibroids can be classified by their location within the uterus and may cause heavy bleeding, cramps, fertility issues, or back/leg pain. Treatment options include medical management with NSAIDs, hormones, or surgery such as myomectomy, hysterectomy, uterine artery embolization, or MRI-guided focused ultrasound.

1. UTERINE FIBROIDS
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R.Anusha,
PharmD Intern,
170514882007.

2. UTERINE FIBROID
 Uterine fibroids are the most common noncancerous
growths of the uterus.
 Monoclonal origin ( arising from single smooth muscle cell
of myometrium)
 Incidence : 20 to 40% of reproductive age women.
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3. Risk factors :-
 African American women are three to five times more likely
to develop fibroids
 Women who are overweight or obese
 Women with a family history also have a higher risk.
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4. Classification:-
Fibroids are generally classified by their location.
 Submucosal Fibroids occur just below the lining of the
uterus
 Intramural Fibroids occur within the uterine wall which can
cause enlargement of the uterus as they grow.
 Subserosal Fibroids grows on the outer wall of the uterus
 Pedunculated fibroids develop when a
submucosal/subserosal fibroid grows a peduncle (stalk).
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6. Clinical presentation:-
 Heavy menstrual bleeding and anemia
 Menstrual cramps and pain
 Problems with fertility or pregnancy
 Backache or leg pains
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7. MANAGEMENT
Asymptomatic fibroids
 Regular follow up every 6 months
 Routine pelvic examination
 Baseline imaging to compare regression
Medical Management for symptomatic fibroids:-
 Not a definitive Rx
 For symptomatic relief
 Preoperatively to decrease the size

8.  NSAIDs
These include mefenamic and ibuprofen.
NSAIDs can be used to treat pain but probably do not
decrease bleeding.
 Tranexamic acid
This non hormonal medication ease menstrual periods.
The dosage is 1300 mg every 8 hours for up to 5 days.
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9.  GnRH Agonists
GnRH agonists are often the drugs of choice.
GnRH agonists can decrease estrogen production. They can
reduce fibroid size and bleeding.
They can cause menopause-like symptoms, including hot
flashes, a tendency to sweat more, vaginal dryness, and, in
some cases, a higher risk of osteoporosis.
GnRH agonists are for short-term use only.
Eg:Triptorelin (Decapeptyl) 3.75 mg or leuprolide depot
3.75 mg I/M or Goseraline (Zoladex) 3.6 mg SC for 3
months
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10.  Exogenous Progestins
Progestins can decrease uterine bleeding but may not shrink
fibroids as much as GnRH agonists.
Medroxyprogesterone acetate 5 to 10 mg orally once a day
or megestrol acetate 40 mg orally once a day taken for 10 to
14 days.
Depot medroxyprogesterone acetate 150 mg IM every 3
months has effects similar to those of continuous oral
therapy.
 Antiprogestins
 Eg:Mifepristone, the dosage is 5 to 50 mg once a day for 3
to 6 months. This dose is lower than the 200-mg dose used
for termination of pregnancy.
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11.  SERMS(Selective Estrogen Receptor Modulators)
Eg:Raloxifene, decreases estrogen levels and shrinks the
fibroid.
 Dose-60 mg /day for 6 to 12 months.
 Danazol
An androgenic agonist, can suppress fibroid growth but has
a high rate of adverse effects (eg, weight gain, acne,
hirsutism, edema, hair loss, deepening of the voice, flushing,
sweating, vaginal dryness) and is thus often less acceptable
to patients.
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12.  Progesterone releasing IUD
Intrauterine device containing Progesteron
LNG(Levonorgestrol) 60 mg and releases 20 ug /day.
Relieve heavy bleeding caused by fibroids.
 Aromatase inhibitors
Directly inhibit estrogen synthesis by inhibiting the enzyme
aromatase which converts androgen to estrogen & rapidly
produce hypoestrogenic state.
 Eg:Letrozole
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13. Surgical options for fibroids include:
 Severe fibroids may not respond to more conservative
treatment options, and surgery may be necessary.
Myomectomy – is the surgical removal of each individual
fibroid without damage to the uterus, preserving a woman’s
ability to conceive.
 Hysterectomy – is the removal of the uterus.The ovaries
may or may not be removed. The common procedure of
choice for fibroid tumors when a woman with symptoms has
completed her family; a woman has excessively large
fibroid tumors; abnormal bleeding occurs.
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14.  Uterine artery embolization (UAE) - These block the
arteries that provide blood flow and cause the fibroids to
shrink.
 Magnetic resonance imaging guided focused ultrasound
surgery (MRGFUS) - An MRI scan locates the fibroids,
and high energy ultrasound waves are delivered to shrink
them.
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15. REFERENCES
 The American College of Obstetricians and
Gynecologists;Womens Healthcare Physicians;FAQ
074;Gynecologic problems;Uterine Fibroids.
 Uterine Fibroids-FDA
 https://www.medicinenet.com › uterine_fibroids ›
article
 https://www.msdmanuals.com › ... › Uterine Fibroids
 https://www.msdmanuals.com › ... › Uterine Fibroids
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