Ask the Pharmacist

Q: I have been diagnosed with uterine fibroids. What are they and is there a pill I can take to ease my symptoms?

A: Uterine fibroids are muscular tumours that grow in the wall of the uterus. While the use of the word tumour can’t help but catch one’s attention, they are almost always benign (i.e. non-cancerous) in nature. This, however, does not make them a simple inconvenience.

Women with fibroids find that they can have an enormous impact on quality of life. Fibroids can grow either on their own or in multiples. They may be as small as a seed or as large as a grapefruit (and rarely, even larger than that) perhaps explaining why they cause such varying degrees of symptoms in those who are diagnosed with this disorder.

They are far from rare, although they do not seem to get a lot of exposure in the media.

It has been estimated that somewhere between 20-80 per cent of females will have one by the age of 50 with the incidence peaking in women in their 40s and early 50s.

As always, some are more at risk of suffering from these than others. Risk factors include having a family history (which triples your risk), being overweight, being of African-American descent, or consuming a diet rich in red meat or ham.

While we have yet to figure out why fibroids occur, there is no doubt that hormones are involved to a large degree. Evidence includes that fibroids tend to grow rapidly during pregnancy when estrogen and progesterone (the two dominant female hormones) levels run high, and stop growing or even shrink when a woman reaches menopause.

While most fibroids are symptom-free, they can be associated with heavy menstrual bleeding (which can be enough to cause anemia in some) and very painful periods, a feeling of fullness in the pelvic area, frequent urination, lower-back pain, pain during intercourse, and enlargement of the lower abdomen. They can also present some complications when it comes to having a family where they have been associated with reproductive problems (including, very rarely, infertility) and a six-time greater risk of requiring a caesarean section during delivery.

A doctor can often detect these with his/her fingers during an ordinary pelvic exam and can use imaging technology, such as an ultrasound, to confirm the diagnosis.

Treatment really comes down to how much of an impact they are having on your life. For those with no symptoms, frequently no treatment is initiated. For those with only mild symptoms, over-the-counter remedies such as ibuprofen and acetaminophen may suffice. Iron supplements may also be required to prevent a deficiency of iron.

For the rest, there are a number of medications that affect hormone levels. A mainstay of therapy is the use of low-dose birth control pills or progesterone-containing options (such as an IUD or the injection Depo-Provera) which help to reduce the heavy bleeding that this condition involves.

Another therapeutic option is drugs which mimic the actions of a gonadotropin-releasing hormone. In doing so, these injections (of which Lupron is the best-known and most-widely used) essentially “switch off” the ovaries causing the fibrous tissue to shrink and the bleeding to stop. While often effective and reasonably well-tolerated, these drugs can come with their share of adverse effects (hot flashes, depression, insomnia, joint pain) and a risk of bone thinning which tends to limit their use to a period of six months or less (after which the fibroids are likely to grow again).

Recently, another drug has been released which works in a different fashion. Fibristal is the first selective progesterone receptor modulator. It works by blocking the effects of progesterone in the uterus while leaving estrogen levels the same. A five-milligram tablet is taken once per day for three straight months followed by a drug-free interval of one full menstrual cycle.

This has been repeated for up to four such cycles in studies, thus far, and seems to be well-tolerated and effective. Fibristal has shown it can significantly reduce fibroid volume, achieve excellent bleeding control rapidly, correct anemia in over 80 per cent of recipients and, most importantly, improve quality of life scores in the majority of women who take it. Only three per cent of females involved in the trials dropped out due to side effects and the incidence of such compare very favourably to those of the gonadotropin-releasing drugs.

Hot flashes and headache were the most common complaints, with pelvic pain, breast tenderness, nausea, acne and vertigo occurring less frequently. It is covered by many private insurance plans as well as by the Ontario government for those whose drugs are paid in part by the province.

Fibristal presents one more solid option to help the many who must deal with the daily frustrations and possible complications that uterine fibroids can bring to their lives.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts