Authors: Bagaria M, Suneja A, Vaid NB, Guleria K, Mishra K.

Study from: Department of Obstetrics and Gynaecology, University College of Medical Sciences, Delhi, India.

Problem: So far, no medication has worked to relieve symptoms of fibroids. In early studies, one drug that appeared to be promising was Mefipristone (RU-486).  Progesterone causes fibroid cells to grow and Mefipristone blocks this effect.

Study: The study included 40 women with bothersome symptoms from fibroids; 20 women were taking mifepristone and 20 were taking a placebo. None of the women or their doctors knew what pill they were taking.

Fibroid-related symptoms, the size of the uterus and size of the largest fibroid were measured with ultrasound at the beginning of the study and every month for three months. A biopsy of the uterine lining cells was done at the beginning and again at the end of treatment.

Results: Women who were taking Mefipristone had a 95% decrease in menstrual blood loss after three months   Complete relief of menstrual cramping occurred in 80%, but only 33% patients were free of pelvic pain.  Women taking the placebo pills had no change in any symptoms. Backache, bladder problems and pain with intercourse were not better in either group.

The size of the uterus and size of the largest fibroid were about 30% smaller by the end of the third month of therapy. Women taking Mefipristone had an increase in haemoglobin (red blood cells) from 9.5 to 11.2 . However, 63% of women taking mefipristone had benign overgrowth of the uterine lining cells (endometrial hyperplasia without atypia).

Authors’ Conclusions: A low dose of mifepristone taken for three months is effective in reducing menstrual bleeding and reducing uterine and fibroid sizes, but has the side-effect of causing uterine lining cell overgrowth.

Dr. Parker’s Comments: It would be great if there was a pill available to treat the symptoms of fibroids with few side-effects.  So far, all the tested medications have either not worked or had bothersome side-effects. Mefipristone is given orally and has few side-effects.  It is well-known that progesterone causes fibroids to grow.  Mefipristone works by blocking the action of progesterone and has been shown to shrink fibroids and decrease bleeding.  However, progesterone decreases the growth of the uterine lining cells and since mefipristone blocks this action it allows the lining cells to overgrow.  After just 3 months almost 2/3 of women had benign overgrowth. While benign overgrowth does not turn into precancer or cancer, the worry is that longer treatment with Mefipristone could stimulate actual cancer cells to form.  Further study will be needed, but this study is discouraging.

For more about medical treatment for fibroids see: http://www.fibroidsecondopinion.com/treatment-for-fibroids/

Authors: James AH, Myers ER, Cook C, Pietrobon R.

Journal: Haemophilia. 2009 Apr 6. [Epub ahead of print]

Study performed at: Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.

Problem: Some women having bleeding complications from surgery that can require blood transfusions or, rarely, even cause serious complications or death. An inherited condition, named von Willebrand disease (VWD) after the man who discovered it, can cause both the heavy bleeding that can lead to having a hysterectomy, and cause sometimes dangerous bleeding during surgery.

Study: The authors wanted to estimate how often women with VWD who had a hysterectomy had serious bleeding or other complications. The United States Nationwide Inpatient Sample (NIS) for the years 1988-2004 was examined for all hysterectomies for non-malignant conditions. The differences between women with and without VWD were analyzed.

Results: 545 women with VWD had a hysterectomy. Women with VWD were more likely to experience bleeding during and after surgery (2.75% vs. 0.89%) and require transfusion (7.34% vs. 2.13%) than women without VWD. One woman with VWD died.

Conclusions: Women with VWD did experience significantly more bleeding complications than women without VWD.

Dr. Parker’s Comments: Because I see a lot of women with fibroids, I also see a lot of women with a history of very heavy menstrual periods. Most often, this is due to fibroids (usually the submucous type). Every once in a while, a woman also has a history of heavy menstrual bleeding since adolescence, heavy bleeding during childbirth or during a previous surgery, or she tells me that her mother or sister hemorrhaged after childbirth or surgery. This is the Red Flag that gets me to send them to a hematologist for evaluation for von Willebrand disease (VWD).

As a result, our consultant hematologist, using simply blood tests, has made the diagnosis of VWD many times. This is good news for the patient. First, VWD does not usually cause serious bleeding unless a woman is having surgery or childbirth, so it is not a frightening diagnosis. Second, there is a medication that can be given in the IV just before surgery or childbirth that prevents serious bleeding and, therefore, avoids the complications described in this study. Third, VWD disease makes it less likely that the fibroids are responsible for the heavy periods and often this changes the treatment options.

So, if you have a history of very heavy periods since adolescence, or you have had heavy bleeding during surgery or after childbirth, or you have a family history of heavy bleeding, then you should ask your doctor about being tested for VWD.