• TRANEXAMIC ACID – not licensed specifically for uterine fibroids
    • Licensed for treatment of cyclic heavy menstrual bleeding
    • Post-hoc analyses from two pivotal Phase 3 studies showed that TA significantly reduced the mean menstrual blood loss in women with fibroids1
    • Given during menses; oral with good safety/tolerability
  • LEVONORGESTREL (LNG) IUD – not licensed specifically for uterine fibroids
    • Licensed use includes treatment of heavy periods in women who choose intrauterine contraception
    • Significant reductions in Visual Bleeding Score shown in a small study comparing LNG-IUD (n=30) and oral progestin (n=30)2
    • Side effects include nausea and irregular bleeding
    • Cost a potential issue
  • COMBINED ORAL CONTRACEPTIVES – not licensed specifically for uterine fibroids
    • Non-contraceptive use includes symptomatic treatment of heavy menstrual bleeding
    • Database searched for all eligible uterine fibroid studies: only two found and evidence for use of COCs is very scarce, low quality and efficacy uncertain3

“Since progesterone is already implicated in the pathogenesis of [uterine fibroids], using progestogens to manage fibroids is like constantly adding fuel to the fire, rendering this treatment ineffective.”4

Donnez J Journal of Clinical Medicine, 20204

  • A review of the most significant papers on the relationship between uterine fibroids and progesterone/progesterones, concludes that the evidence points to a lack of evidence of any efficacy4
  • GnRH AGONISTS
    • Monthly or quarterly injections
    • Duration limited due to side effects: significant bone mineral density loss, hot flushes, vaginal dryness5,6
  • SPRMs
    • Synthetic steroid ligands with a progesterone receptor target and tissue-selective effects of agonist and antagonist activities (ulipristal acetate)7
    • Recently identified cases of liver toxicity leading to liver failure; approved for use in EU and Canada but with restrictions
    • Use limited to short-term treatment before surgery
    • Longer-term treatment only in women with uterine fibroids not eligible for surgery