Treatment
There is almost no high quality evidence on which to base treatment strategies.There is a striking lack of strong literature to support the effectiveness of specific therapies, or to provide important information on long term outcomes. There are no randomised trials to support the superiority of one treatment over the other, be it well established procedures like myomectomy or the relatvely new procedure, Uterine Artey Embolisation (UAE).

Medical treatment for fibroids
Fibroid growth is dependent on the availability of estrogen. This is evident from the fact that fibroids grow the reproductive years, including in pregnancy whereas fibroids regress after menopause. Medical treatment is aimed at controlling the symptoms or in achieving a low estrogen state (pseudo menopause) resulting in reduction of the size of the fibroids.

Heavy periods due to fibroids may be treated with a variety of medications used to treat menorrhagia due to an unknown cause. This includes non steroid anti inflammatory drugs like mefenamic acid. Tranexamic acid is an anti fibrinolytic agent that modifies the coagulation system and thus reduces blood loss from the uterus.

Injections of gonadotrophin releasing hormone agonist (GnRH agonist) are aimed atachieving a hypoestrogenic state thus reducing the size of the fibroid and fibroid related symptoms. But this does not achieve a permanent reduction in the size of the fibroids. Once the injections are stopped the fibroids grow back to their original size within a very short time. This treatment is mainly used prior to plaanned surgery in order to reduce the size of the fibroids thus reducing the risks and complications of surgery.

There are several possible future medical treatments for leiomyoma. Mifepristone, a progesterone antagonist has shown reduction in the size of the fibroid in a few studies. Androgenic agents like danazol and gestrinone are not commonly used because of the severe side effects. Other hormonal preparations like the contraceptive pill, progestins like medroxyprogesterone acetate, depomedroxyprogesterone acetate and norethindrone do not consistently reduce the amount of blood loss in menorrhagia due to fibroids.