Uterine fibroids: Should I use GnRH-a therapy?

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Use GnRH-a to shrink fibroids before surgery, to stop heavy bleeding, or to treat symptoms for a short time before menopause.
Choose another method to treat uterine fibroids, such as over-the-counter pain medicine, fibroid embolization, birth control pills, or surgery.

This Decision Point is for women who have decided to treat their uterine fibroids.

If you're thinking about surgery for fibroids, see Uterine fibroids: Should I have surgery?

If you're thinking about embolization for fibroids, see Uterine fibroids: Should I have uterine fibroid embolization?

If you also have problems with infertility, you may want to try another treatment. For more information, see the topic Fertility Problems.

Key points to remember

Taking gonadotropin-releasing hormone analogue (GnRH-a) puts your body into a state like menopause for as long as you take it. This shrinks fibroids. After you stop taking it, your fibroids may grow back.
Taking GnRH-a can cause serious side effects, such as bone loss. To limit side effects, you take it for no longer than several months.
GnRH-a therapy may be a good choice if you are close to menopause (when fibroids shrink), have heavy bleeding from fibroids, or are planning surgery. This medicine usually is not used to relieve fibroid symptoms only, because fibroids grow back fairly quickly after treatment stops.
It's possible—but not likely—for you to get pregnant while taking GnRH-a. Be sure to use a barrier method of birth control, such as a condom.

FAQs

What are uterine fibroids?

Uterine fibroids are growths in the uterus. They are not cancer. Fibroids can grow on the inside of the uterus , within the muscle wall of the uterus , or on the outer surface of the uterus . They can change the shape of the uterus as they grow. This can make it hard for you to get pregnant, or it can cause problems during a pregnancy.

Over time, the size, shape, location, and symptoms of fibroids may change.

As women get older, they are more likely to have uterine fibroids, especially from their 30s and 40s until menopause. About 80 out of 100 women have uterine fibroids by the time they reach age 50.¹ Most have mild or no symptoms. But fibroids can cause bad pain, bleeding, bowel blockage, and other problems.

The cause of fibroids is not known. But the hormones estrogen and progesterone can make them grow. A woman's body makes the highest levels of these hormones during her childbearing years. After menopause, when hormone levels decrease, fibroids often shrink or disappear.

When do fibroids need to be treated?

Uterine fibroids usually need treatment when they cause:

Anemia from heavy fibroid bleeding.
Ongoing low back pain or a feeling of pressure in the lower belly.
Trouble getting pregnant because a fibroid changes the shape of the uterus or the location of the fallopian tubes.
Problems during pregnancy, such as miscarriage or premature labor.
Blockage of the urinary tract or bowels.
Infection, if the tissue of a large fibroid dies.

Depending on the reasons you need treatment, one type of treatment may work better for you than another.

How does GnRH-a therapy work?

This medicine puts your body into a state like menopause for as long as you take it. This lowers your body's estrogen. This estrogen decrease:

Stops menstrual periods.
Stops the growth of and reduces the size of uterine fibroids.

GnRH-a therapy is not usually used to relieve pain and bleeding only, because fibroids grow back fairly quickly after you stop taking GnRH-a. But it is sometimes used to shrink large fibroids before fibroid surgery or to stop heavy bleeding from fibroids.

For women who are close to menopause (when fibroids will shrink on their own), short-term relief from GnRH-a therapy can be a good choice.

Why might your doctor recommend GnRH-a?

You have severe bleeding from uterine fibroids and need treatment right away.
Other treatments for fibroids haven't helped your symptoms, and you're planning surgery later.
You're close to menopause, when fibroids will get smaller or go away.
You're planning to have surgery to take out large fibroids.
You're not planning on getting pregnant soon.

2. Compare Options

	Take GnRH-a	Don't take GnRH-a
What is usually involved?	GnRH-a is given one of three ways: It can be injected into a muscle once a month. It is also available in a dose that lasts for 3 months. It can be injected under the skin of your belly once every 28 days. Or you can spray it into your nose twice a day. You probably will take it for only 3 to 6 months to avoid long-term side effects. It's possible, though not likely, that you can get pregnant while taking this medicine. Use a barrier method of birth control, such as condoms, if you want to keep from getting pregnant.	You can take nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain. You can take birth control pills to control bleeding from fibroids. You can have fibroid embolization to shrink your fibroids. You can have surgery to take out your uterus or just the fibroids. If you're close to menopause, you can try to live with the symptoms for a while. Fibroids get smaller or go away after menopause.
What are the benefits?	Your symptoms may get better or go away, because fibroids usually shrink to about half their original size.^2,³ You can treat your fibroids briefly until menopause, when fibroids will get smaller on their own. GnRH-a can shrink fibroids before surgery to remove them. This makes fibroids easier to remove and can reduce the risk of bleeding during surgery and problems after surgery.	You won't have side effects such as hot flashes and vaginal dryness. You won't have possible bone loss from the medicine. Fibroid embolization may give longer-lasting relief from your symptoms than GnRH-a. Surgery to remove your uterus would cure your fibroids. But this is a good choice only if you don't want to have children (or more children).
What are the risks and side effects?	GnRH-a can cause bone loss if you take it for longer than 6 months. The medicine gives you symptoms like those from menopause, such as hot flashes and vaginal dryness. The medicine only treats fibroids for a while. Fibroids tend to grow back after you stop taking GnRH-a.	Your symptoms could get worse. Fibroids could make it hard for you to get pregnant. You could have pain or infection from fibroid embolization. Surgery without taking GnRH-a first may be more likely to lead to problems from bleeding or infection. You could have side effects from taking NSAIDs. Birth control pills have possible side effects, such as headaches and light or skipped periods. They may be a risky choice if you smoke or have heart disease.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Uterine Fibroids.

Personal stories about hormone therapy for uterine fibroids

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was surprised when my doctor told me uterine fibroids could be the cause of the pain I was having with my periods. He told me all about fibroids and the treatments I could try. When he said a medication called Lupron might stop the pain, I thought I might as well try it. The medication worked. I used the Lupron for about 6 months and then stopped taking it. I hardly have any pain now, and my periods are much lighter. "

— Gina, age 43

"I first noticed that my periods were getting worse about a year ago. I wasn't too concerned, but I discussed the pain with my doctor when I went for a Pap smear. My exam and Pap smear were fine. My doctor said that uterine fibroids could be the cause of my pain. Since my mom and an older sister have had uterine fibroids, I thought that must be it. My doctor talked to me about my options. She told me that using birth control pills and ibuprofen would be the best way to start. Now my periods are lighter. And, when I start taking ibuprofen a few days before my period starts, it really helps relieve my pain. "

— Amy, age 32

"The pain before and during my periods was so bad, I couldn't exercise. I am an active person, and the pain was really getting me down. I have had uterine fibroids for years and have tried ibuprofen and other nonprescription medicines, but they were not helping anymore. When I went to see my doctor about the pain, she said maybe it was time for surgery. I asked if there were any other options, since the last time I had surgery it took me months to recover. I didn't want to go through that again. My doctor said a medicine called Lupron might help me. She said that it has side effects, so I can't take it for longer than 6 months. That's okay, because menopause is right around the corner for me, and fibroids get better after menopause. After starting the medicine, I did have more hot flashes than usual, but my heavy menstrual bleeding and menstrual pain are almost gone. I think taking this medicine works well for me. "

— Patricia, age 52

"I started having really painful menstrual periods about 3 years ago. My doctor asked a lot of questions about my periods and did an exam and some tests. Most of the tests came back normal, but my doctor thought, based on the ultrasound, that uterine fibroids might be the cause of my pain. I tried using a birth control patch for a few months, along with ibuprofen, but it didn't work too well. However, it was enough of an improvement to make life tolerable. I really don't want to use any stronger stuff like Lupron, because it makes you feel like you're in menopause! "

— Susan, age 37

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take GnRH-a for fibroids

Reasons not to take GnRH-a for fibroids

My symptoms are bad, and other treatments haven't helped.

I can control my symptoms with other treatments.

More important

Equally important

More important

I'm only taking it for a few months, so I'm not worried about side effects.

I don't want to take any chance of having side effects.

More important

Equally important

More important

I want to treat my fibroids, even if they might come back.

I don't want to take hormones if they won't cure my fibroids.

More important

Equally important

More important

I don’t plan to get pregnant.

I don't want to have to wait to get pregnant.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking GnRH-a

NOT taking GnRH-a

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. Is GnRH-a a good choice to treat fibroids if you're close to menopause?

Yes
No
I'm not sure

You're right. GnRH-a may be a good choice to treat fibroids if you are close to menopause. After menopause, fibroids get smaller or go away.

2. Will GnRH-a prevent pregnancy while you take it?

Yes
No
I'm not sure

You're right. It is possible, though not likely, to get pregnant while taking GnRH-a. Use a barrier form of birth control, such as condoms, if you don't want to get pregnant.

3. Are side effects likely when you take GnRH-a?

Yes
No
I'm not sure

You're right. GnRH-a can cause bone loss if you take it for more than a few months. That's why doctors prescribe it only for short-term use. It also causes symptoms like those of menopause.

Decide what's next.

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Day Baird D, et al. (2003). Highly cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. American Journal of Obstetrics and Gynecology, 188(1): 100–107.
American College of Obstetricians and Gynecologists (2000). Surgical alternatives to hysterectomy in the management of leiomyomas. ACOG Technical Bulletin No. 16. Obstetrics and Gynecology, 95(5): 1–9.
Haney AF (2003). Leiomyomata. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 869–887. Philadelphia: Lippincott Williams and Wilkins.