Uterine fibroids are a common condition that affects millions of women each year. While the cause of uterine fibroids is unknown, there is a clear relationship between hormones and these tumors. In this blog post, we will discuss what fibroids are, the symptoms they cause, and the hormones associated with them. We will also talk about how hormonal treatment methods can help reduce or eliminate the symptoms of uterine fibroids. Finally, we will list and describe different hormonal treatment methods and how to know which method is best for you.
Uterine fibroids are non-cancerous tumors that grow in the uterus. Uterine fibroids can cause a wide range of symptoms, including pain, heavy bleeding, and infertility. Symptoms of uterine fibroids can vary depending on the size, location, and number of tumors present. However, the most common symptom is abnormal menstrual bleeding, and many women also have pelvic pain or pressure. Other symptoms may include:
- heavy or prolonged menstrual bleeding
- bleeding between periods
- pain during sexual intercourse
- frequent urination
- constipation
- back pain
How are hormones related to fibroids?
While the cause of uterine fibroids is unknown, there is a clear relationship between hormones and these tumors. Estrogen and progesterone are the two main hormones involved in the development of uterine fibroids. However, testosterone may also play a role.
Estrogen
Estrogen is a hormone that is produced by the ovaries. Estrogen is responsible for the development and growth of the uterine lining during the menstrual cycle. It also plays a role in the development of uterine fibroids. When estrogen levels are high, it can promote the growth of fibroid tumors.
Progesterone
Progesterone is a hormone that is produced by the ovaries. Progesterone is responsible for preparing the uterine lining for pregnancy. It also helps to control the growth of the uterine lining during the menstrual cycle. If an egg is fertilized, then progesterone levels increase. Otherwise, progesterone levels will fall and a new menstrual cycle will start. When it comes to fibroids, however, progesterone does not hold them back. Research shows that fibroid cells depend on both estrogen and progesterone to grow, which is one reason fibroids tend to shrink after menopause, when both hormones decline.
Testosterone
Recently, testosterone levels in women have also been evaluated for their effect on fibroids. Although primarily known as a male sex hormone, testosterone is also naturally produced by females in small amounts. So far, the results have been conflicting: some studies have linked higher testosterone levels to a higher risk of fibroids, while a large genetic study linked higher testosterone to a lower risk. The role of testosterone in fibroids remains uncertain.
Does Hormone Therapy Work?
Although hormone therapy is often used as a treatment for fibroids, it is important to note that hormone therapy does not eliminate fibroids. Instead, hormone therapy can regulate the menstrual cycle and decrease severe symptoms, and some medications, such as GnRH agonists and antagonists, can temporarily shrink fibroids. Once these medications are stopped, fibroids usually start growing again. Not only that, but estrogen-lowering medications can cause side effects that are similar to symptoms experienced during menopause, such as hot flashes, vaginal dryness, mood swings, and bone loss, and most hormonal treatments prevent pregnancy while they are being taken. For these reasons, your doctor may recommend combining hormone therapy with another treatment designed to remove fibroids. In some cases, they may recommend against hormone therapy and may suggest another treatment entirely.
In order to shrink fibroids, uterine fibroid embolization (UFE) may be recommended. UFE is a minimally invasive procedure that blocks the blood supply to the fibroids, causing them to shrink. This approach significantly reduces symptoms and often prevents the need for more invasive procedures. UFE is often performed as an outpatient procedure and is done under sedation rather than general anesthesia.
Myomectomy is a surgical option for treating fibroids. Myomectomy involves removing the fibroid tumors while leaving the healthy tissue of the uterus intact. Myomectomy can be performed using various surgical techniques, including laparoscopic surgery, robotic surgery, and open surgery. Hysterectomy is another surgical option that involves removing the entire uterus. This is usually only recommended when other treatment options have failed or if the fibroids are very large.
In Conclusion
In this blog, we discussed what uterine fibroids are, their symptoms, and the relationship between hormones and fibroids. We also reviewed some of the treatment options that are available, such as hormone therapy, uterine fibroid embolization (UFE), and surgical options. If you suspect that you may have fibroids, it is important to talk to your doctor so that they can properly diagnose and treat you.
Sources
- Management of Symptomatic Uterine Leiomyomas: ACOG Practice Bulletin, Number 228. American College of Obstetricians and Gynecologists / Obstet Gynecol, 2021.
- Uterine fibroids. N Engl J Med, 2013.
- Causal relationship between female reproductive factors, sex hormones and uterine leiomyoma: a Mendelian randomization study. Reprod Biomed Online, 2024.
- Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy. N Engl J Med, 2021.
- Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev, 2014.
- Uterine fibroids and uterine fibroid embolization (UFE) treatment. Society of Interventional Radiology.