What are the different treatment options for uterine fibroids?
Progestins
Combined hormonal contraceptives
GnRH agonists
Selective progesterone receptor modulators (SPRMs)
Progestins can be used for abnormal uterine bleeding associated with myomatosis, but the reduction in tumor volume has not been confirmed.
Combining estrogens with progestins is also a strategy for managing abnormal uterine bleeding. This therapy can induce endometrial atrophy and stabilize the endometrium, but the size of the fibroid does not change.
GnRH agonists decrease the volume of fibroids by 30-60%, reduce local blood flow, and decrease cell size. The maximum effect is achieved at 12 weeks, but the most important adverse effect is bone loss. Once discontinued, fibroids often regrow.
SPRMs are a family of progesterone receptor ligands with mixed agonist-antagonist properties depending on the cellular and molecular context. Small controlled studies suggest that SPRMs may be suitable for the treatment of fibroids.