Fibroids: a drug to reduce heavy menstrual bleeding

Affecting 20 to 40% of Caucasian women and up to 50% of African American women over the age of 35, uterine fibroids are tumors located on the wall of the uterus, either alone or in groups.

Although benign, these fibroids can, in some cases, be particularly troublesome for women who have them. In addition to possible fertility problems, they also cause severe pain, frequent urges to urinate or heavy menstrual bleeding.

It is therefore recommended that these patients turn to more or less invasive and radical methods: embolization, myomectomy, that is to say the removal of fibroids and the repair of the uterus and, in the majority of cases, hysterectomy. In the last two cases, the surgical intervention is important and requires a long sick leave.

Researchers may have found an alternative to surgery. In a study published in the New England Journal of Medicinethey report the effectiveness of a new drug in reducing heavy menstrual bleeding in women with uterine fibroids.

A 50% reduction in bleeding

Called elagolix, this oral tablet reduces the production of estrogen and progesterone hormones normally produced by a woman’s ovaries. When these hormones are suppressed, fibroids generally become smaller and bleeding is reduced.

The drug was tested in 790 women, aged 18 to 51, with heavy bleeding due to fibroids: one group received elagolix, a second group received elagolix, plus a low dose of of estrogen and progesterone as replacement therapy in the hope that the additional hormones would produce the same beneficial effects but reduce the side effects of elagolix used alone. A third group received identical placebo pills that did not contain elagolix or replacement hormones.

Results showed that 80.4% of women treated with elagolix alone had a reduction in menstrual bleeding
by 50% or more, compared to 9.6% of women in the placebo group. Among women treated with elagolix and hormone replacement therapy, 72% experienced a reduction in menstrual bleeding of 50% or more.

Side effects to better control

If elagolix can be an alternative to surgery, it remains to reduce the side effects (such as hot flushes and loss of bone density) associated with taking it. Combining it with replacement hormones could be the solution: women who were treated with a low dose of estrogen and progesterone in addition to elagolix showed no decrease in their bone density.

“The potential value of an easily reversible, oral drug that can be combined with a low dose of ‘add back’ hormones to reduce heavy menstrual bleeding while avoiding symptoms and problematic side effects could be a big step forward. forward,” says Dr. William Schlaff, chair of the department of obstetrics and gynecology at Sidney Kimmel Medical College at Thomas Jefferson University, Australia.