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
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?
|
|
|
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.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.
- 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
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
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.
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.
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!
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?
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?
- 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.
3.
Are side effects likely when you take GnRH-a?
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.
3.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Key concepts that you understood
Key concepts that may need review
Credits
| Credits |
Healthwise Staff |
| Primary Medical Reviewer |
Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer |
Divya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology |
References
Citations
- American College of Obstetricians and
Gynecologists (2008 reaffirmed 2010). 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.
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- 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, 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.
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 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.
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.
- 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
Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.
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."
"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."
"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!"
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?
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?
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?
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.
3.
Use the following space to list questions, concerns, and next steps.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer |
Divya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology |
References
Citations
- American College of Obstetricians and
Gynecologists (2008 reaffirmed 2010). Alternatives to hysterectomy in the management of
leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387–399.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Last Revised:
June 23, 2011
American College of Obstetricians and
Gynecologists (2008 reaffirmed 2010). Alternatives to hysterectomy in the management of
leiomyomas. ACOG Practice Bulletin No. 96. Obstetrics and Gynecology, 112(2, Part 1): 387–399.
