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
- 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 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.
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, bowel blockage, 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.
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 because a fibroid changes the shape of the uterus or the location of the fallopian tubes.
- Problems during pregnancy, such as miscarriage or premature labor.
- Blockage of 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.
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.
- 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
What is usually involved?
What are the benefits?
What are the risks and side effects?
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.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.
- 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.
- Surgery without taking GnRH-a first may be more likely to lead to problems from bleeding or infection.
- 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.
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.
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.
I don't plan to get pregnant.
I don't want to have to wait to get pregnant.
My other important reasons:
My other important reasons:
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.
NOT taking GnRH-a
What else do you need to make your decision?
Check the facts
Is GnRH-a a good choice to treat fibroids if you're close to menopause?
- YesYou'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.
- NoSorry, that's not 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.
- I'm not sureIt may help to go back and read "Get the Facts." GnRH-a may be a good choice to treat fibroids if you are close to menopause. After menopause, fibroids get smaller or go away.
Will GnRH-a prevent pregnancy while you take it?
- YesNo, that's not 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.
- NoYou'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.
- I'm not sureIt may help to go back and read "Get the Facts." 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.
Are side effects likely when you take GnRH-a?
- YesYou'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.
- NoSorry, that's not 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.
- I'm not sureIt may help to go back and read "What are the risks and side effects?" in the "Compare Your Options" chart. GnRH-a can cause bone loss and symptoms of menopause.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Divya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology|
Last Updated:April 19, 2013