05 June 2024 : Review article
Advancements and Emerging Therapies in the Medical Management of Uterine Fibroids: A Comprehensive Scoping Review
Jarosław Krzyżanowski
1ABCDEF*, Tomasz Paszkowski 1ADE, Piotr Szkodziak 1DE, Sławomir Woźniak 1ADEF
DOI: 10.12659/MSM.943614
Med Sci Monit 2024; 30:e943614
Table 1 Current medical treatment options for uterine fibroids.
| Treatment option | References | Current state of the art | Limitations | Future scope |
|---|---|---|---|---|
| GnRH antagonists | Donnez 2021;Giudice 2022;Elagolix FDA approval 2018, 2020;Linzagolix EMA approval 2022;ACOG 2021 | Relugolix and linzagolix approved for the treatment of UFNew Drug Application for linzagolix withdrawn in the USA | Limited duration of the therapyHormonal add back therapy recommended to mitigate side effects | Safety evaluation of extended therapeutic regimens |
| GnRH agonists | ACOG 2021;Takeda 2022;Lee 2022 | Effective in short term management of abnormal uterine bleeding and reduction in the size of UF | Limited duration of the therapyHormonal add back therapy recommended to mitigate side effectsUFs return to their original size in 3–9 months | Safety evaluation of extended therapeutic regimens |
| Levonorgestrel-releasing intrauterine device | ACOG 2021;Gerkowicz 2019;Kashani 2016 | Effective, safe and reversible contraceptionReduction in the quantity and duration of menstrual bleedingEndometrial hyperplasia prevention | Limited use in the cases of uterine cavity deformations or congenital uterine anomalies | Assessment of the viability of treatment time extension up to 8 years with single device |
| Depot medroxyprogesterone acetate | Harmon 2015;Harmon 2022 | Long acting, injectable contraceptiveSeems to decrease the risk of UF development | Data limited to studies on African American women | Comparative studies on other races |
| Combined oral contraceptives | ACOG 2021;Kwas 2021;Assiri 2022 | Reduced menstrual bleedingPotential protective effect against UF | Contraindications to estrogen use such as breast cancer, liver disease, migraine with aura | Further studies to confirm protective effect against UF |
| Aromatase inhibitors | Committee opinion N. 663. 2016;Sayyah-Melli 2017;Mizoguchi 2016;Ando 2017 | Reduction in size and symptoms of UF | Common side effects like hot flushes, bone loss, insomnia | Comparative research with other drugsPotential use of hormonal add block therapy |
| Gestrinone | Ciebiera 2017;Zhu 2012 | Reduction in UF and uterus size | Very limited data, lack of randomized trials | Randomized trials to assess its safety and efficacy |
| Danazol | Kashani 2016 | Reduction in UF size.Induction of endometrial atrophy | Very limited dataOther drugs likely with superior effects | Comparative randomized trials to asses efficacy when compared with other treatments |
| Selective progesterone receptor modulators | ACOG 2021;Dinis-Oliveira 2021;Ulpristal Acetate use restriction 2021 | Effective in the treatment of abnormal uterine bleedingReduction in UF size | Limited indications after cases of severe liver damage possibly caused by ulipristal acetate | Further studies to assess safety and risk of liver damage |
| Selective estrogen receptor modulators | Chung 2014;Deng 2012 | Reduction in UF size | No recent patient-based studies on safety and efficacy available | Randomized studies regarding its efficacy and patients’ safety |
| Selective estrogen receptor degraders | Hernando 2021 | Fulvestrant approved in the treatment of breast cancer | Uncertain impact on UF | Further research to assess their impact on UF |
| Tranexamic acid | 14, 18, 35, 36ACOG 2021;Kashani 2016;Fusca 2019;Eder 2013 | Effective in reduction of menstrual blood loss | Gastrointestinal side effectsIts effect may not be sufficient to prevent anemia | The use of tranexamic acid in combined therapy |
| Non-steroidal anti-inflammatory drugs | Bofill Rodriguez 2019 | Reduction in menstrual blood loss | Limited evidence for its efficacy.Patients may still suffer from menorrhagia | Research regarding their use in combined therapy |
| UF – uterine fibroid. | ||||