Abstract
Symptomatic fibroids are one of the most common reasons women undergo surgical intervention (hysterectomy, myomectomy, endometrial ablation) or other invasive interventions (uterine artery embolization). Although pharmacologic therapy with GnRH analogues, Danazol, RU486 and NSAIDs are occasionally prescribed, rarely are oral contraceptives (OCPs) prescribed for either fibroid prevention or treatment of symptoms. It appears that OCPs are underutilized as a first-line treatment option because of the common belief that OCPs will stimulate fibroid growth and worsen symptoms. This paper reviews the literature on the effects of OCPs on fibroids and evaluates the prevalence of OCP use in a subset of women with fibroids presenting for uterine artery embolization (UAE). From 1/98 through 11/98, women who presented for a UAE were consecutively evaluated under an IRB protocol and data were collected on the reasons for their requesting UAE, the symptoms they were experiencing and what treatment options they had been offered before coming in for UAE. Information was also collected on the number of women who had been treated pharmacologically (ie low dose OCPs) and who had been admitted to a hospital for a surgical procedure (ie myomectomy, D&C, endometrial ablation) before presenting for a UAE. Information also was collected by a MEDLINE search on the effect of OCPs on uterine fibroids. Eighty-four women between the ages of 29 and 60 with symptomatic leiomyoma presented for uterine artery embolization. Three of the women in this cohort had prior surgery. None of the women had been given OCPs as treatment for their pelvic pathology. The literature did not support the association of the use of low dose OCPs and fibroid growth. Women in this cohort with the chief complaint of leiomyomatous uterus had not been offered low dose OCPs. It appears that practitioners are still concerned about possible fibroid growth with low dose OCPs. Education in this area is important to dispel misconceptions about OCP use in women with uterine leiomyoma. As well, there is a need for more research that evaluates the benefits of low dose OCPs in this subset of women.