title: [Role of medical treatment for symptomatic leiomyoma management in premenopausal women].
abstract: The most frequent symptom with leiomyoma is menometrorrhagia. However, it can be responsible of pelvic pain, dysmenorrhea or urinary and digestive compression when it is particularly voluminous. These recommandations were made in order to review medical management of fibroids. If no therapy is able to have them disappear, various drugs may reduce their related symptoms. Tranexamic acid, non-steroidal anti-inflammatory drugs and high dose of oestrogen may be useful in the management of acute hemorrhagic disorders. Progestin, such as lynestrenol induces small reduction in leiomyoma volume and moderate increase in hemoglobin level before surgery. Pregnane and nor-pregnane may improve menstrual bleeding in short or mild delays. The use of Gonadotropin Releasing Hormone (GnRH) agonists can reduce menstrual bleeding with hemoglobin recovery. Add-back therapy using tibolone seems interesting since secondary effects encountered with GnRH agonists may be reduced. Levonorgestrel-releasing intrauterine system is proven to reduce increased menstrual bleeding and restore hemoglobin level. Aminoglutethimide and fadrozole have been underevaluated to conclude when letrozole seems as efficient as GnRH agonists to reduce leiomyoma volume and provide less hot flushes. Anastrozol is associated with reduction in leiomyomata volume, pain and menstrual bleeding. Mifepristone reduces the size of uterine leiomyomata, improves symptomatology, but could be associated with development of endometrial hyperplasia. SPRM evaluated in females have shown to improve leiomyoma related symptomatology. Danazol could be useful to reduce leiomyoma related symptoms in short terms. Tamoxifen and raloxifen show modest overall benefit. Because of insufficient data concerning fulvestrant, pirfenidone or interferon, their prescription cannot be recommended in patients with leiomyomata.
authors: Servie de gynécologie obstétrique, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France. martin.koskas@bch.aphp.fr
authors: M
authors: M
authors: Koskas
authors: N
authors: N
authors: Chabbert-Buffet
authors: S
authors: S
authors: Douvier
authors: C
authors: C
authors: Huchon
authors: E
authors: E
authors: Paganelli
authors: J
authors: J
authors: Derrien
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003267:Contraception / Q000379:methods; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D007889:Leiomyoma / Q000150:complications / Q000188:drug therapy*; D008599:Menstruation Disturbances / Q000188:drug therapy* / Q000209:etiology; D017441:Necrobiotic Disorders / Q000150:complications / Q000188:drug therapy / Q000209:etiology; D017697:Premenopause / Q000187:drug effects / Q000502:physiology; D013997:Time Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000150:complications / Q000188:drug therapy*
chemical_list: D018931:Antineoplastic Agents, Hormonal