Main Page Risk Factors Symptoms Diagnosis Treatment Screening Reducing Your Risk Talking to Your Doctor Living With Fibroids Resource Guide Medications for Uterine Fibroids by Ricker Polsdorfer, MD En Español (Spanish Version) The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor. Direct treatment of fibroids attempts either to shrink them or to reduce the bleeding they cause. These drug therapies are used to treat the symptoms without curing the problem. Prescription Medications Progestins Progesterone (Crinone) Medroxyprogesterone acetate (Cycrin, Provera) Norethindrone acetate (Aygestin) Megestrol Acetate (Megace) Progestins are one of the active ingredients in birth control pills. They reduce menstrual blood flow by altering the hormonal balance of the body in a fashion similar to pregnancy. Norethindrone is given 2.5-10 milligrams per day by mouth for 5-10 days each menstrual cycle. Megestrol is given 10-20 milligrams per day by mouth for 10-14 days each menstrual cycle. Medroxyprogesterone is given 5-10 milligrams per day by mouth for 10-14 days each menstrual cycle or 150 mg by injection every three months. The long-acting shots are usually used after a trial of pills, in case the side effects prove uncomfortable. Damage to early pregnancy Not recommended for the first four months of a pregnancy. Change in menstrual pattern Sleepiness Dizziness Headache Constipation Nausea Nervousness Depression Breast enlargement Raloxifene Raloxifene is an estrogen-blocking agent. Because fibroids sometimes depend on the presence of estrogen to help Page 1 of 5
grow or maintain themselves, blocking estrogen may stop growth or even shrink fibroid tumors. It has the additional benefit of helping to maintain bone density. Hot flashes Sweating Leg cramps Rarely, blood clots in the legs, lungs, or eyes Fadrozole Fadrozole is an aromatase-inhibitor. Aromatase-inhibitors interfere with a crucial step in estrogen s synthesis in the body, thus decreasing the amount of circulating estrogen. Deprived of estrogen, fibroids often shrink. With long-term use, possible side effects include: Bone loss Acceleration of cardiovascular disease Danazol This is a synthetic male hormone. It can suppress growth of fibroids, but has a high incidence of adverse side effects. Damage to early pregnancy Life-threatening blood clots Weight gain Acne Hirsutism (abnormal hair growth) Edema Hair loss Deepening of the voice Flushing Sweating Vaginal dryness GnRH Agonists Gonadorelin (Lutrepulse) Histrelin (Supprelin) Nafarelin (Synarel) These drugs, which stimulate the production of estrogen and progesterone in the ovaries via the pituitary when present normally in low and changing amounts, have the opposite effect when given in higher, steady doses thereby largely eliminating the production of estrogen and progesterone. Their primary use is in other conditions, but they have proven effective in reducing the size of fibroids, usually in anticipation of surgery. They are given by injection, subdermal pellet (inserted under the skin), or nasal spray. Page 2 of 5
Rebound fibroid growth within six months Rapid bone loss Multiple pregnancy Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Indomethacin (Indocin) Naproxen (Naprosyn, Anaprox) Celecoxib (Celebrex) In addition to pain relief, NSAIDs can reduce menstrual flow by what appears to be a separate effect. Their most common side effect is stomach irritation. The newer and more expensive selective NSAIDs (celecoxib) are expected to produce fewer gastrointestinal problems. Stomach irritation, ulceration, and bleeding Kidney damage Narcotics and Their Derivatives Codeine Pentazocine (Talwin) Morphine Meperidine (Demerol) Fentanyl (Duragesic) Hydromorphone (Dilaudid) Methadone Oxycodone (Oxycontin) There is no substitute for narcotics in the treatment of severe pain. Because they are addictive and can be abused, they are tightly controlled by the Federal Drug Enforcement Agency (DEA). Most important side effects include: Death or coma from failure to breathe or circulatory collapse Dizziness Sleepiness Nausea and vomiting Constipation Over-the-Counter Medications Page 3 of 5
Pain Relief Aspirin Nonsteroidal anti-inflammatory drugs (NSAIDs) Ibuprofen (Motrin, Advil) Naproxen (Aleve) Piroxicam (Feldene) Sulindac ( Clinoril) There are minor differences among the available pain relief agents in terms of dosing intervals, frequency of certain side effects, and other characteristics. Stomach irritation, ulceration, and bleeding Kidney damage Acetaminophen/Paracetamol Tylenol Panadol This is a common painkiller used for mild to moderate pain. In ordinary doses, acetaminophen is considered very safe. Do not drink alcohol when taking these medications. may damage blood cells or cause rashes Overdoses can damage the liver Special Considerations Whenever you are taking a prescription medication, take the following precautions: Take them as directed not more, not less, not at a different time. Do not stop taking them without consulting your doctor. Don t share them with anyone else. Know what effects and side effects to expect, and report them to your doctor. If you are taking more than one drug, even if it is over-the-counter, be sure to check with a doctor or pharmacist about drug interactions. Plan ahead for refills so you don t run out. When to Contact Your Doctor If your symptoms become worse If your medications are causing side effects REFERENCES: Page 4 of 5
American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/publications/patient_education/bp074.cfm. Accessed June, 30, 2008. The Merck Manual of Diagnosis and Therapy. 17th ed. Merck and Co; 1999. Last reviewed September 2011 by Ganson Purcell Jr., MD, FACOG, FACPE Last Updated: 9/1/2011 Page 5 of 5