Using typical birth control pills has long been a starting point for the treatment of heavy menstrual bleeding in women with uterine fibroids. Oral contraceptives (OCPs) contain hormones that are helpful at preventing pregnancy by keeping a woman from ovulating or releasing an egg with each cycle. At the same time, these hormones regulate the body’s natural estrogen and progesterone levels which can reduce heavy bleeding related to fibroids.
It is important to choose the right type of OCP for women with fibroids, as birth control pills that contain higher levels of estrogen can actually allow fibroids to continue growing. While bleeding may improve, other bulk symptoms like pelvic pain and urinary frequency can persist or get worse.
Low estrogen or progesterone-only medications are more appropriate, as they can control mild fibroid symptoms without further fibroid growth. For women with large or many fibroids, these medications may not provide adequate relief, or they may lose their effectiveness over time.
GnRH Antagonists for Fibroid Treatment: Lesser-Known Side Effects
A stronger group of medications including Orilissa, Oriahnn, and Myfembree have been developed and marketed for women with heavy menstrual bleeding. These potent medications are called GnRH antagonists. They have a powerful effect on the brain and reduce sex hormone levels. While more effective than OCPs at reducing heavy menstrual bleeding, these medications have frequent and significant side effects that are similar to what women experience in early menopause.
Short-term side effects include flushing, nausea, headache, insomnia, fatigue, anxiety, night sweats, and decreased libido. Sexual dysfunction and vaginal atrophy can also be seen.
A study funded by the makers of Orilissa and Oriahnn and written in part by paid consultants for the company was published in 2020 in the New England Journal of Medicine. In the study, 60% of women experienced at least one side effect with a significant number of women needing to discontinue treatment due to these symptoms.
Understanding the Fine Print in Orilissa, Oriahnn, Myfembree
In addition to these short-term side effects, there are more significant long-term side effects that every woman taking these medications should be aware of. In fact, the drug company has placed a warning label on the medications, and there are details of these precautions in the fine print. Because of these longer-term side effects, these medications can only be prescribed for a limited time period, making them a temporary option for treatment.
The most significant concern is the risk of developing osteoporosis due to permanent bone loss. This is an especially high risk for women already taking steroids, some seizure medicines, and certain types of heartburn medication. Women who already have osteoporosis should not take these medications.
Another major concern is the risk of worsening depression, and women with this diagnosis should not take these medications. In the group of women in the study for these medications, there were more women thinking about suicide, and one patient in the Orilissa trial committed suicide.
Hormonal medications are known to increase the risk of blood clots which can lead to potentially devastating diseases like pulmonary embolism (PE), deep venous thrombosis (DVT), stroke, and heart attack.
Orilissa, Oriahnn, and Myfembree have these same concerns. Women who already have a risk factor for forming blood clots are not recommended to take these medications. These risk factors include high blood pressure, high cholesterol, obesity, vascular disease, and any women over the age of 35 who smoke cigarettes.
The study also uncovered some issues related to the liver. Lab tests revealed wild fluctuation in lab values related to liver function. The long-term effect of this was not clear, but there is still a concern for many women who may already have liver problems like cirrhosis or hepatitis.
Why Medications for Fibroid Aren’t Worth It
An important factor to consider in evaluating new medications is how effective they are compared to existing treatments. The same study in the New England Journal of Medicine showed that the medications in Orilissa (elagolix) and Oriahnn (elagolix + estradial + norethindrone) were not as effective as existing treatments like uterine fibroid embolization (UFE) or surgery.
- Of the women taking the medication in Orilissa, only 69-77% had a major improvement in menstrual blood loss at the end of 6 months.
- Of the women taking the medications in Oriahnn, only 77-84 % had major improvement in menstrual blood loss at the end of 6 months.
By comparison, Uterine Fibroid Embolization (UFE), a minimally invasive treatment for uterine fibroids performed by interventional radiologists like Dr. Lipman and Dr. Ermentrout at the Atlanta Fibroid Center, has greater than 90% effectiveness at resolving symptoms related to fibroids. UFE is also more effective at treating bulk-related symptoms like pelvic pain, pelvic pressure, and urinary frequency.
In the right circumstance and for the right patient, these medications can offer a temporary improvement in heavy menstrual bleeding. However, it is critical that women are aware of the risks of the medications like Orilissa, Oriahhn, and Myfembree and make an informed decision when starting treatment. Most of the women on these medications will eventually need to have a more definitive treatment.
What Is a Safer Option to Mitigate Fibroid Symptoms?
Fibroids are benign tumors and surgeries like hysterectomy and myomectomy are the most extreme treatment options. Given the significant consequences that women can face with invasive surgery, for many women, these should be the options of last resort. Sadly, invasive surgery is often the first and only option given to women.
Uterine Fibroid Embolization (UFE) is an outstanding, non-surgical, outpatient procedure with a 90% success rate in treating women with symptomatic fibroids. It has a 25-year track record of safety and efficacy and has been endorsed by the American College of Obstetricians & Gynecologists for women suffering from symptomatic fibroids that want to keep their uterus.
Dr. John Lipman and Dr. Mitchell Ermentrout of the renowned Atlanta Fibroid Center® have performed more UFE procedures than anyone in the world. They are both double board-certified and nationally trusted authorities in the nonsurgical treatment of uterine fibroids. Their personalized care and unparalleled experience have improved the lives of thousands of women and their families. To learn more about the Atlanta Fibroid Center®, please go to ATLii.com or their YouTube channel.