What drugs can be used to treat uterine fibroids?

Since uterine fibroids are related to estrogen, most drugs used to treat fibroids are related to lowering estrogen levels or antagonizing estrogen. Commonly used drugs include:

1. Gonadotropin-releasing hormone agonist GnRHa

GnRHa can cause amenorrhea in most patients, and three months of treatment can reduce the size of the patient's fibroids by about 35-65%, but within a few months of stopping the drug, the size of the fibroids will gradually return to the size before treatment. Therefore, the effect is temporary, and it is mainly used for large fibroids that are difficult to undergo laparoscopic or hysteroscopic surgery. Scaling the fibroids can reduce the difficulty of surgery.

2. Aromatase inhibitors

Aromatase inhibitors can reduce tissue ovarian and peripheral estrogen production and lower estrogen levels after 1 day of use. Based on their mechanism of action, these drugs are more rapid in onset but have far fewer side effects than GnRH analogs. Several small studies and case reports have observed that aromatase inhibitors can reduce the size and symptoms of uterine fibroids.

3. Mifepristone

Mifepristone's antiprogestin activity works by targeting the higher-than-normal levels of progesterone receptors in uterine fibroids. Several studies have shown that high-dose mifepristone can reduce fibroid size by approximately 26-74%. Its effectiveness is comparable to that of gonadotropin analogs, and the recurrence rate of fibroids after stopping mifepristone is lower. Amenorrhea rates can reach 90% after the use of mifepristone, and bone density remains stable while pelvic compression improves. Side effects of mifepristone include endometrial hyperplasia, endometrial cancer, and transient increases in transaminase levels.

There is currently a lack of a simple, inexpensive, safe and effective long-term drug treatment for uterine fibroids. This means that symptomatic uterine fibroids are still mainly treated surgically.