Uterine Fibroids: Should I Use GnRH-A Therapy?

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Uterine Fibroids: Should I Use GnRH-A Therapy?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Uterine Fibroids: Should I Use GnRH-A Therapy?

Get the facts

Your options

  • Use
    GnRH-a to shrink fibroids before surgery, to stop
    heavy bleeding, or to treat symptoms for a short time before menopause.
  • Choose another method to treat uterine fibroids, such as
    over-the-counter pain medicine,
    fibroid embolization, birth control pills, or
    surgery.

This decision aid is for women who have decided to
treat their uterine fibroids. Many fibroids do not need treatment.

If you've decided to treat your uterine fibroids, you may also need to make a decision about embolization or a decision about surgery.

If you also have problems with
infertility, you may want to try another treatment.

Key points to remember

  • Taking
    gonadotropin-releasing hormone analogue (GnRH-a) puts
    your body into a state like menopause for as long as you take it. This shrinks
    fibroids. After you stop taking it, your fibroids may grow
    back.
  • Taking GnRH-a can cause serious side effects, such as bone
    loss. To limit side effects, you take it for no longer than several
    months.
  • GnRH-a therapy may be a good choice if you are close to
    menopause (when fibroids shrink), have heavy bleeding
    from fibroids, or are planning surgery. This medicine usually is not used to
    relieve fibroid symptoms only, because fibroids grow back fairly quickly after
    treatment stops.
  • It's possible—but not likely—for you to get pregnant while
    taking GnRH-a. Be sure to use a barrier method of birth control, such as a
    condom.
FAQs

What are uterine fibroids?

Uterine fibroids are
growths in the
uterus. They are not cancer.
Fibroids can grow on the
inside of the uterus,
in the muscle wall of the uterus, or on the
outer surface of the uterus. They can change the shape of the uterus as they
grow. This can make it hard for you to get pregnant, or it can cause problems
during a pregnancy.

Over time, the size, shape, location, and
symptoms of fibroids may change.

As women get older, they are more
likely to have uterine fibroids, especially from their 30s and 40s until
menopause.
Most have mild or no symptoms. But fibroids can cause bad
pain, bleeding, and other problems.

The cause of
fibroids is not known. But the hormones
estrogen and
progesterone can make them grow. A woman's body makes
the highest levels of these hormones during her childbearing years. After
menopause, when hormone levels decrease, fibroids often shrink or
disappear.

When do fibroids need to be treated?

Uterine
fibroids usually need treatment when they cause:

  • Anemia from
    heavy fibroid bleeding.
  • Ongoing low back pain or a feeling of
    pressure in the lower belly.
  • Trouble getting pregnant.
  • Problems during
    pregnancy, such as preterm labor.
  • Problems with the urinary tract or bowels.
  • Infection,
    if the tissue of a large fibroid dies.

Depending on the reasons you need treatment, one type of
treatment may work better for you than another.

How does GnRH-a therapy work?

This medicine puts
your body into a state like menopause for as long as you take it. This lowers
your body's estrogen. This estrogen decrease:

  • Stops menstrual periods.
  • Stops
    the growth of and reduces the size of uterine fibroids.

GnRH-a therapy is not usually used to relieve pain and
bleeding only, because fibroids grow back fairly quickly after you stop taking
GnRH-a. But it is sometimes used to shrink large fibroids before fibroid
surgery or to stop heavy bleeding from fibroids.

For women who
are close to menopause (when fibroids will shrink on their own), short-term
relief from GnRH-a therapy can be a good choice.

Why might your doctor recommend GnRH-a?

  • You have severe bleeding from uterine
    fibroids and need treatment right away.
  • Other treatments for fibroids haven't helped your symptoms, and
    you're planning surgery later.
  • You're close to menopause, when fibroids will get smaller or go
    away.
  • You're planning to have surgery to take out large
    fibroids.
  • You're not planning on getting pregnant soon.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Take GnRH-a
Take GnRH-a

  • GnRH-a is given one
    of three ways:

    • It can be injected into a muscle once a
      month. It is also available in a dose that lasts for 3 months.
    • It
      can be injected under the skin of your belly once every 28 days.
    • Or
      you can spray it into your nose twice a day.
  • To avoid long-term side effects, you probably will take it for only 3 to 6 months.
  • It's possible, though not likely,
    that you can get pregnant while taking this medicine. Use a barrier method of
    birth control, such as condoms, if you want to keep from getting
    pregnant.
  • Your
    symptoms may get better or go away, because fibroids usually shrink to about
    half their original size.footnote 1
  • You can treat
    your fibroids briefly until menopause, when fibroids will get smaller on their
    own.
  • GnRH-a can shrink fibroids before surgery to remove them. This
    makes fibroids easier to remove and can reduce the risk of bleeding during
    surgery and problems after surgery.
  • GnRH-a can cause bone
    loss if you take it for longer than 6 months.
  • The medicine may give
    you symptoms like those from menopause, such as hot flashes and vaginal
    dryness.
  • The medicine only treats fibroids for a while. Fibroids tend to
    grow back after you stop taking GnRH-a.
Don't take GnRH-a

Don't take GnRH-a

  • You can take
    nonsteroidal anti-inflammatory drugs (NSAIDs) to treat
    pain.
  • You can take birth control pills to control bleeding from
    fibroids.
  • You can have
    fibroid embolization to shrink your fibroids.
  • You can have surgery to take out your uterus or just the
    fibroids.
  • If you're close to menopause, you can try to live with
    the symptoms for a while. Fibroids get smaller or go away after
    menopause.
  • You won't have side effects
    such as hot flashes and vaginal dryness.
  • You won't have possible bone loss from the
    medicine.
  • Fibroid embolization may give longer-lasting relief from
    your symptoms than GnRH-a.
  • Surgery to remove your uterus would cure your fibroids. But this
    is a good choice only if you don't want to have children (or more
    children).
  • Your symptoms
    could get worse.
  • Fibroids could make it hard for you to get
    pregnant.
  • You could have pain or infection from fibroid
    embolization.
  • You could have side effects from taking
    NSAIDs.
  • Birth control pills
    have possible side effects, such as headaches and light or skipped periods.
    They may be a risky choice if you smoke or have heart disease.

Personal stories about hormone therapy for uterine fibroids

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I first noticed that my periods were
getting worse about a year ago. I wasn't too concerned, but I discussed the
pain with my doctor when I went for a Pap smear. My exam and Pap smear were
fine. My doctor said that uterine fibroids could be the cause of my pain. My mom and an older sister have had uterine fibroids, so I thought that must be
it. My doctor talked to me about my options. She told me that using birth
control pills and ibuprofen would be the best way to start. Now my periods are
lighter. And, when I start taking ibuprofen a few days before my period starts,
it really helps relieve my pain.

Amy, age 32

The pain
before and during my periods was so bad, I couldn't exercise. I am an active
person, and the pain was really getting me down. I have had uterine fibroids
for years and have tried ibuprofen and other nonprescription medicines, but
they were not helping anymore. When I went to see my doctor about the pain, she
said maybe it was time for surgery. I asked if there were any other options,
since the last time I had surgery it took me months to recover. I didn't want
to go through that again. My doctor said a hormone
medicine might help me. She said that it has side effects, so I
can't take it for longer than 6 months. That's okay, because menopause is right
around the corner for me, and fibroids get better after menopause. After
starting the medicine, I did have more hot flashes than usual, but my heavy
menstrual bleeding and menstrual pain are almost gone. I think taking this
medicine works well for me.

Patricia, age 52

I started having really painful menstrual
periods about 3 years ago. My doctor asked a lot of questions about my periods
and did an exam and some tests. Most of the tests came back normal, but my
doctor thought, based on the ultrasound, that uterine fibroids might be the
cause of my pain. I tried using a birth control patch for a few months, along
with ibuprofen, but it didn't work too well. But it was enough of an
improvement to make life tolerable. I really don't want to use any stronger
hormone medicine, because it makes you feel like you're in
menopause!

Susan, age
37

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take GnRH-a for fibroids

Reasons not to take GnRH-a for fibroids

My symptoms are bad, and other treatments haven't helped.

I can control my symptoms with other treatments.

More important
Equally important
More important

I'm only taking it for a few months, so I'm not worried about side effects.

I don't want to take any chance of having side effects.

More important
Equally important
More important

I want to treat my fibroids, even if they might come back.

I don't want to take hormones if they won't cure my fibroids.

More important
Equally important
More important

I don't plan to get pregnant.

I don't want to have to wait to get pregnant.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking GnRH-a

NOT taking GnRH-a

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Is GnRH-a a good choice to treat fibroids if you're close to menopause?
2, Will GnRH-a prevent pregnancy while you take it?
3, Are side effects likely when you take GnRH-a?

Decide what's next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure


Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Martin J. Gabica, MD - Family Medicine
Primary Medical Reviewer Elizabeth T. Russo, MD - Internal Medicine
Specialist Medical Reviewer Divya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology

References
Citations
  1. American College of Obstetricians and Gynecologists (2008, reaffirmed 2012). Alternatives to hysterectomy in the management of leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387–399.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Uterine Fibroids: Should I Use GnRH-A Therapy?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Use
    GnRH-a to shrink fibroids before surgery, to stop
    heavy bleeding, or to treat symptoms for a short time before menopause.
  • Choose another method to treat uterine fibroids, such as
    over-the-counter pain medicine,
    fibroid embolization, birth control pills, or
    surgery.

This decision aid is for women who have decided to
treat their uterine fibroids. Many fibroids do not need treatment.

If you've decided to treat your uterine fibroids, you may also need to make a decision about embolization or a decision about surgery.

If you also have problems with
infertility, you may want to try another treatment.

Key points to remember

  • Taking
    gonadotropin-releasing hormone analogue (GnRH-a) puts
    your body into a state like menopause for as long as you take it. This shrinks
    fibroids. After you stop taking it, your fibroids may grow
    back.
  • Taking GnRH-a can cause serious side effects, such as bone
    loss. To limit side effects, you take it for no longer than several
    months.
  • GnRH-a therapy may be a good choice if you are close to
    menopause (when fibroids shrink), have heavy bleeding
    from fibroids, or are planning surgery. This medicine usually is not used to
    relieve fibroid symptoms only, because fibroids grow back fairly quickly after
    treatment stops.
  • It's possible—but not likely—for you to get pregnant while
    taking GnRH-a. Be sure to use a barrier method of birth control, such as a
    condom.
FAQs

What are uterine fibroids?

Uterine fibroids are
growths in the
uterus. They are not cancer.
Fibroids can grow on the
inside of the uterus ,
in the muscle wall of the uterus , or on the
outer surface of the uterus . They can change the shape of the uterus as they
grow. This can make it hard for you to get pregnant, or it can cause problems
during a pregnancy.

Over time, the size, shape, location, and
symptoms of fibroids may change.

As women get older, they are more
likely to have uterine fibroids, especially from their 30s and 40s until
menopause.
Most have mild or no symptoms. But fibroids can cause bad
pain, bleeding, and other problems.

The cause of
fibroids is not known. But the hormones
estrogen and
progesterone can make them grow. A woman's body makes
the highest levels of these hormones during her childbearing years. After
menopause, when hormone levels decrease, fibroids often shrink or
disappear.

When do fibroids need to be treated?

Uterine
fibroids usually need treatment when they cause:

  • Anemia from
    heavy fibroid bleeding.
  • Ongoing low back pain or a feeling of
    pressure in the lower belly.
  • Trouble getting pregnant.
  • Problems during
    pregnancy, such as preterm labor.
  • Problems with the urinary tract or bowels.
  • Infection,
    if the tissue of a large fibroid dies.

Depending on the reasons you need treatment, one type of
treatment may work better for you than another.

How does GnRH-a therapy work?

This medicine puts
your body into a state like menopause for as long as you take it. This lowers
your body's estrogen. This estrogen decrease:

  • Stops menstrual periods.
  • Stops
    the growth of and reduces the size of uterine fibroids.

GnRH-a therapy is not usually used to relieve pain and
bleeding only, because fibroids grow back fairly quickly after you stop taking
GnRH-a. But it is sometimes used to shrink large fibroids before fibroid
surgery or to stop heavy bleeding from fibroids.

For women who
are close to menopause (when fibroids will shrink on their own), short-term
relief from GnRH-a therapy can be a good choice.

Why might your doctor recommend GnRH-a?

  • You have severe bleeding from uterine
    fibroids and need treatment right away.
  • Other treatments for fibroids haven't helped your symptoms, and
    you're planning surgery later.
  • You're close to menopause, when fibroids will get smaller or go
    away.
  • You're planning to have surgery to take out large
    fibroids.
  • You're not planning on getting pregnant soon.

2. Compare your options

  Take GnRH-a Don't take GnRH-a
What is usually involved?
  • GnRH-a is given one
    of three ways:

    • It can be injected into a muscle once a
      month. It is also available in a dose that lasts for 3 months.
    • It
      can be injected under the skin of your belly once every 28 days.
    • Or
      you can spray it into your nose twice a day.
  • To avoid long-term side effects, you probably will take it for only 3 to 6 months.
  • It's possible, though not likely,
    that you can get pregnant while taking this medicine. Use a barrier method of
    birth control, such as condoms, if you want to keep from getting
    pregnant.
  • You can take
    nonsteroidal anti-inflammatory drugs (NSAIDs) to treat
    pain.
  • You can take birth control pills to control bleeding from
    fibroids.
  • You can have
    fibroid embolization to shrink your fibroids.
  • You can have surgery to take out your uterus or just the
    fibroids.
  • If you're close to menopause, you can try to live with
    the symptoms for a while. Fibroids get smaller or go away after
    menopause.
What are the benefits?
  • Your
    symptoms may get better or go away, because fibroids usually shrink to about
    half their original size.1
  • You can treat
    your fibroids briefly until menopause, when fibroids will get smaller on their
    own.
  • GnRH-a can shrink fibroids before surgery to remove them. This
    makes fibroids easier to remove and can reduce the risk of bleeding during
    surgery and problems after surgery.
  • You won't have side effects
    such as hot flashes and vaginal dryness.
  • You won't have possible bone loss from the
    medicine.
  • Fibroid embolization may give longer-lasting relief from
    your symptoms than GnRH-a.
  • Surgery to remove your uterus would cure your fibroids. But this
    is a good choice only if you don't want to have children (or more
    children).
What are the risks and side effects?
  • GnRH-a can cause bone
    loss if you take it for longer than 6 months.
  • The medicine may give
    you symptoms like those from menopause, such as hot flashes and vaginal
    dryness.
  • The medicine only treats fibroids for a while. Fibroids tend to
    grow back after you stop taking GnRH-a.
  • Your symptoms
    could get worse.
  • Fibroids could make it hard for you to get
    pregnant.
  • You could have pain or infection from fibroid
    embolization.
  • You could have side effects from taking
    NSAIDs.
  • Birth control pills
    have possible side effects, such as headaches and light or skipped periods.
    They may be a risky choice if you smoke or have heart disease.

Personal stories

Personal stories about hormone therapy for uterine fibroids

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I first noticed that my periods were getting worse about a year ago. I wasn't too concerned, but I discussed the pain with my doctor when I went for a Pap smear. My exam and Pap smear were fine. My doctor said that uterine fibroids could be the cause of my pain. My mom and an older sister have had uterine fibroids, so I thought that must be it. My doctor talked to me about my options. She told me that using birth control pills and ibuprofen would be the best way to start. Now my periods are lighter. And, when I start taking ibuprofen a few days before my period starts, it really helps relieve my pain."

— Amy, age 32

"The pain before and during my periods was so bad, I couldn't exercise. I am an active person, and the pain was really getting me down. I have had uterine fibroids for years and have tried ibuprofen and other nonprescription medicines, but they were not helping anymore. When I went to see my doctor about the pain, she said maybe it was time for surgery. I asked if there were any other options, since the last time I had surgery it took me months to recover. I didn't want to go through that again. My doctor said a hormone medicine might help me. She said that it has side effects, so I can't take it for longer than 6 months. That's okay, because menopause is right around the corner for me, and fibroids get better after menopause. After starting the medicine, I did have more hot flashes than usual, but my heavy menstrual bleeding and menstrual pain are almost gone. I think taking this medicine works well for me."

— Patricia, age 52

"I started having really painful menstrual periods about 3 years ago. My doctor asked a lot of questions about my periods and did an exam and some tests. Most of the tests came back normal, but my doctor thought, based on the ultrasound, that uterine fibroids might be the cause of my pain. I tried using a birth control patch for a few months, along with ibuprofen, but it didn't work too well. But it was enough of an improvement to make life tolerable. I really don't want to use any stronger hormone medicine, because it makes you feel like you're in menopause!"

— Susan, age
37

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take GnRH-a for fibroids

Reasons not to take GnRH-a for fibroids

My symptoms are bad, and other treatments haven't helped.

I can control my symptoms with other treatments.

             
More important
Equally important
More important

I'm only taking it for a few months, so I'm not worried about side effects.

I don't want to take any chance of having side effects.

             
More important
Equally important
More important

I want to treat my fibroids, even if they might come back.

I don't want to take hormones if they won't cure my fibroids.

             
More important
Equally important
More important

I don't plan to get pregnant.

I don't want to have to wait to get pregnant.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking GnRH-a

NOT taking GnRH-a

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Is GnRH-a a good choice to treat fibroids if you're close to menopause?

  • Yes
  • No

  • I'm not sure

You're right. GnRH-a may be a good choice to treat fibroids if you are close to menopause. After menopause, fibroids get smaller or go away.

2.
Will GnRH-a prevent pregnancy while you take it?

  • Yes

  • No
  • I'm not sure

You're right. It is possible, though not likely, to get pregnant while taking GnRH-a. Use a barrier form of birth control, such as condoms, if you don't want to get pregnant.

3.
Are side effects likely when you take GnRH-a?

  • Yes
  • No

  • I'm not sure

You're right. GnRH-a can cause bone loss if you take it for more than a few months. That's why doctors prescribe it only for short-term use. It also causes symptoms like those of menopause.

Decide what's next

1.
Do you understand the options available to you?

2.
Are you clear about which benefits and side effects matter most to you?

3.
Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2.
Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

 

Credits
By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Martin J. Gabica, MD - Family Medicine
Primary Medical Reviewer Elizabeth T. Russo, MD - Internal Medicine
Specialist Medical Reviewer Divya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology

References
Citations
  1. American College of Obstetricians and Gynecologists (2008, reaffirmed 2012). Alternatives to hysterectomy in the management of leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387–399.

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