The most frequent symptom with
leiomyoma is menometrorrhagia. However, it can be responsible of
pelvic pain,
dysmenorrhea or urinary and digestive compression when it is particularly voluminous. These recommandations were made in order to review medical management of
fibroids. If no
therapy is able to have them disappear, various drugs may reduce their related symptoms.
Tranexamic acid, non-steroidal anti-inflammatory drugs and high dose of oestrogen may be useful in the management of acute
hemorrhagic disorders.
Progestin, such as
lynestrenol induces small reduction in
leiomyoma volume and moderate increase in
hemoglobin level before surgery. Pregnane and nor-pregnane may improve menstrual
bleeding in short or mild delays. The use of
Gonadotropin Releasing Hormone (
GnRH) agonists can reduce menstrual
bleeding with
hemoglobin recovery. Add-back
therapy using
tibolone seems interesting since secondary effects encountered with
GnRH agonists may be reduced.
Levonorgestrel-releasing intrauterine system is proven to reduce increased menstrual
bleeding and restore
hemoglobin level.
Aminoglutethimide and
fadrozole have been underevaluated to conclude when
letrozole seems as efficient as
GnRH agonists to reduce
leiomyoma volume and provide less hot flushes. Anastrozol is associated with reduction in leiomyomata volume,
pain and menstrual
bleeding.
Mifepristone reduces the size of uterine leiomyomata, improves symptomatology, but could be associated with development of
endometrial hyperplasia. SPRM evaluated in females have shown to improve
leiomyoma related symptomatology.
Danazol could be useful to reduce
leiomyoma related symptoms in short terms.
Tamoxifen and raloxifen show modest overall benefit. Because of insufficient data concerning
fulvestrant,
pirfenidone or
interferon, their prescription cannot be recommended in patients with leiomyomata.