Medical management of Myoma in young age who is having menorrhagia ?? Drugs available??

 

Medical management of Myoma in young women :- -Possibly as many as 80% of all women have uterine fibroids. While the majority usually have no symptoms, 1 in 4 end up with symptoms severe enough to require treatment . There are many agents used for medical management of symptomatic myoma and choice of drug depends on her size, location of myoma , symp and age . The list of such drugs is long 1) NSAIDs-when menorrhagia-related to myoma is the chief concern. However such myoma-related meno can be controlled  also by  2) COC  or Progestins-if myoma-related symptoms are limited to  periods  only—by causing thinning of endo 3) LNG-IUS –if there is no cavitary irregularities 4) Androgens-like Danazol / Gestrinone –not favored for their unacceptable side effects 5) GnRH agonists as either monthly basis 3.75 mg ( as IM or Sub cut)-/ Long acting 11.25mg  –on 3 monthly basis but  bone loss in Trabecular bone will be >6%  after 6 months of agonist Inj if no add back 6) In research settings Antagonists have also been used with good success but frequency of Inj are unacceptable even in depot form 7) Mifepristone / Ulipristal:-SERMs... A word of caution:-No 6 & 7 has not been approved by any International / National Drug Regularly Authority. UPA.

What are the different receptors of progesterone?? Which type of receptor is commonly observed   in myomatous cells? - Out of the two known receptors of Progesterone (PR-A & PR-B) -- it is the A type that are more frequently seen densely (much more) than B at tumor cells.

S PRMs, also called as Anti progestins-as such pharmacological agent exert anti progesterone effects by exerting antagonistic effects on a receptors of progesterone-that is why such class of drugs are aptly termed as SELECTIVE.

  First drug to choose for medl management of myoma-where bleeding (Menorrhagia) is not the primary concern. Yes, Dr Daljit is possibly right. If meno is primary intention to treat then NSAID & COC should be considered first à or LNG IUS if there is no Cavitary distortion. Review of much literature on this topic which spanned in the entire day (05-05-17) led me to conclude like that. Though if U thinks of medl TR of myoma -first choice is still agonist, second choice will be mifepristone:-Mifepristone reduces the volume of myoma by 50%. People have used Mifepristone as 2.5 mg, 5, 10, even 50 mg for over 3 months continuously. But then again there are some associated medl disorders where Mifepristone can’t be used e.g. those who are on steroid Ry for some other diseases, on Aspirins, smokers, hepatic-renal parenchymal diseases.