Breakthroughs In Uterine Fibroid Treatment Improves Quality Of Life For Women
Prevention and Treatment Women suffering from uterine fibroids can now look forward to a course of treatment that promises significant relief from most symptoms.
One of them is the only medical treatment approved by Health Canada, and the first in this new class of medications called selective progesterone receptor modulators.
That’s positive news for women experiencing symptoms caused by uterine fibroids — specifically, benign tumours that grow on the walls of the uterus. It’s a widespread condition with 80 percent of African American women and 70 percent of Caucasian women developing the condition in their lifetimes. Almost half of those have significant and often disabling symptoms.
“We know a low blood or iron count due to heavy periods are under diagnosed and under treated...”
Though fibroids are benign, the ramifications of them are not. A recent Canadian survey of more than 9,000 women found with uterine fibroids determined that this group lost more work days, had greater levels of distress, and spent more money on feminine hygiene products than the general population. Meanwhile, a woman’s emotional wellbeing and the way she lives her life is also affected. In an international epidemiological survey of 21,000 women, 54 percent of those women with uterine fibroids said that it negatively impacted their lives. Of that 54 percent, sexual life was the most negatively impacted aspect followed by work performance, and relationships involving family or considered personal.
There are significant physical effects as well, including heavy menstrual bleeding, anemia, difficulty concentrating (due to low iron levels), fatigue, and discomfort. “The most significant of these symptoms of uterine fibroids is heavy menstrual bleeding,” says Dr. Sony Singh, Vice Chair of Gynecology at The Ottawa Hospital. “That usually starts the whole process rolling. Often patients are told this is normal. But, we know a low blood or iron count due to heavy periods are under diagnosed and under treated — so women are quite uncomfortable about seeing a physician to get the care needed.”
“There is also a significant social and economic impact in terms of costs to the health care system and the care needed,” explains Dr. Singh. “It is equivalent to other chronic diseases like diabetes and arthritis. We don’t talk about this much because it is a reproductive issue. People don’t like to discuss things like periods, but it’s important to bring awareness and advocacy for women who are suffering.”
Now, with the introduction of this new therapy, there is a minimally invasive, non-surgical treatment option to address many of the issues uterine fibroids pose for patients, physicians, and other healthcare professionals. Patients are encouraged to discuss this treatment with their doctor. It’s reflective of a change in thinking about treatment that points to medical management as a first preferred approach before last resort surgical procedures. In Canada, the majority of hysterectomies (about 30 percent) are done as a result of uterine fibroids. For women of child-bearing age who hope to conceive, it has life-changing consequences.
"We don’t talk about this much because it is a reproductive issue. People don’t like to discuss things like periods, but it’s important to bring awareness and advocacy for women who are suffering."
The new treatment is a daily pill taken for three continuous months, offering improvement for patients. This course of treatment can be repeated, if needed. “The drug is most effective in controlling heavy menstrual bleeding in women with fibroids,” says Dr. Singh. “Women who have heavy bleeding can get good control of their periods with this medication while waiting for surgery or as an alternative to it. Those who want to avoid surgery long term can actually take several courses of treatment — and that is exciting as well.”
Studies show that long-term, intermittent use of this oral treatment maximizes potential key benefits, including: bleeding control (rapid onset), anemia correction, fibroid size, and improvement in quality of life. Dr. Singh adds, “It’s one of those medications that actually changes the fibroid itself and can shrink it. It’s quite good in the majority of patients for controlling their symptoms.”
In February 2015, the Journal of Obstetrics and Gynecology of Canada published new clinical practice guidelines on uterine fibroids. Evidence pointed to the therapy for anemia correction and the treatment of abnormal uterine bleeding and bulk symptoms, such as pelvic pressure and pain. In regards to the new treatment option, the journal stated: “Of all of the hormonal options available for women with uterine fibroids, ulipristal acetate has the most rapid documented onset of action and control of bleeding.”
“Today, we have more tools available for women than ever before,” says Dr. Singh. “We have our traditional options, but also this new drug available. With the more choices we have, we can find something that works best for the individual. Patients now have greater choice.”