Degeneration or growth of a fibroid causes acute pain that can become chronic, with continuing degeneration. After diagnosis, a pelvic examination is repeated in 4 to 6 mo to determine if the fibroid is growing rapidly. For stable fibroids, annual follow-up is sufficient. For asymptomatic patients, no treatment is required. For patients with symptoms, medical options, including suppression of estrogen to stop the bleeding, are suboptimal and limited.
Exogenous progestins can partially suppress estrogen stimulation of uterine fibroid growth.
Depot medroxyprogesterone acetate 150 mg IM q 3 mo controls bleeding similarly to continuous oral therapy and provides contraception. GnRH agonists given by IM injection, subdermal pellet, or nasal spray are most helpful when given preoperatively to reduce fibroid and uterine volume. In general, these drugs should not be used for continued therapy because rebound growth to pretreatment size within 6 mo is common, often increasing bleeding and pain. Long-term GnRH therapy is also associated with rapid bone loss and is therefore not approved. Giving estrogen concurrently is being studied to determine whether its long-term use can prevent the bone loss.