Medical Hormonal Management Options

For women with fibroids, heavy bleeding, or endometriosis

by Marcelle Pick, OB/GYN NP

If you suffer from symptomatic fibroids, heavy bleeding or endometriosis, you might be able to avoid a hysterectomy with the right medical management and care. For those who cannot avoid hysterectomy, therapeutic and medical care and management can help minimize the impact of surgery. The great news is you have a number of options, including various types of oral contraceptives, progesterone/progestin hormones, and GnRH agonists.

Certain forms of birth control pills have proven to help some women. The
progestin component can sometimes offset the stimulating effect of her
own estrogen, but not always since birth control pills also contain synthetic

The Mirena intrauterine system (IUD) is another option to consider. It
releases a synthetic progestin inside the uterus. Though it’s available as
birth control, it also helps control bleeding issues and can prevent the
need for hysterectomy in some women.

At the Women to Women clinic, we try to use natural progesterone
products for these purposes whenever possible, such as Prometrium,
prescription capsules or custom-compounded micronized progesterone
products. If contraception is also desired, birth control pills and the Mirena
are appropriate options to consider.

Sometimes women are prescribed Lupron, a type of GnRH agonist, to
bring on a sudden, temporary “medical menopause” in an attempt to shrink
fibroids or reduce endometrial implants. GnRH agonist drugs are
modified versions of the naturally occurring hormone known as
gonadotropin releasing hormone, which plays a role in regulating the
menstrual cycle. These drugs are normally used preoperatively in order to
improve ease of surgery. They may also be used in the treatment of
endometiosis. Additionally, Lupron inhibits ovarian function and severely decreases a woman’s estrogen and hormone production as well. This creates some uncomfortable side effects, including instant menopausal symptoms and potentially significant thinning of the bone. Women are usually prescribed the drug for 3–6 months and then evaluated to see how their symptoms have improved. Many of these women do go on to have surgery.

Realizing that knowledge is power is important, because as you become
more knowledgeable you are able to make the right decisions for you. No
one knows your body as well as you do.