Can a daily pill lighten heavy menstrual bleeding caused by fibroids?

Many women develop benign uterine fibroids, which may cause heavy menstrual bleeding, a problem that may be more severe among Black women. A new daily medication approved by the FDA may help some women by lightening blood loss during monthly periods. The post Can a daily pill lighten heavy menstrual bleeding caused by fibroids? appeared first on Harvard Health Blog.

Can a daily pill lighten heavy menstrual bleeding caused by fibroids?

Fibroids are generally benign (not cancerous) tumors that form within the tissues of the uterus. They are very common in reproductive-age women: studies report that up to 70% of white women and 80% of Black women may develop fibroids by age 50. And research suggests Black women are more likely to experience severe or very severe symptoms related to fibroids, such as heavy and sometimes prolonged monthly periods.

In some cases, women seek medical care due to menstrual bleeding so heavy that they develop anemia and require iron supplements or, much more rarely, blood transfusions. Now, a new medicine taken as a daily pill may help some women reduce heavy bleeding caused by fibroids.

Surgery and injections help some women

Until recently, the treatment options for heavy bleeding due to fibroids were limited to surgical procedures or an injection of a medication called leuprolide, which is given monthly or every three months to help shrink fibroids and lighten bleeding. While these treatments are effective for some women, each has risks and disadvantages:

  • Any surgical procedure comes with a risk of infection. Additionally, excess bleeding requiring transfusion, hysterectomy (removal of the uterus), injury to other pelvic or abdominal organs, and recurrence of the fibroids are possible. In some cases, fertility is affected as well.
  • Regular injections of leuprolide have significant side effects, as this medication essentially puts women into medically induced menopause. Therefore, it is typically used only as a bridge to surgery.

What does research tell us about a new approach to fibroid-related heavy menstrual bleeding?

The new medicine approved by the FDA to treat heavy menstrual bleeding due to fibroids is Oriahnn. It’s a daily pill that combines two hormones (a form of estrogen called estradiol, plus norethindrone acetate) with a medication called elagolix. Elagolix helps inhibit a hormone that causes a woman’s body to release estrogen and progesterone during her monthly menstrual cycle.

A recently published trial demonstrated that elagolix effectively decreases blood loss during menses, and causes high rates of amenorrhea (no bleeding at all). The trial was performed in conjunction with AbbVie, the company that produces and markets Oriahnn. It studied 433 women who had fibroids and heavy menstrual bleeding for 12 months per woman over a period of 2.5 years.

One strength of the study is that 67% of the women who participated were Black. Black women have higher rates of uterine fibroids, so their inclusion in this study is particularly important.

The study compared two groups of women for one year: one group received just elagolix, and the other received elagolix with estradiol and norethindrone acetate (“add-back therapy”). Because elagolix suppresses hormonal release of estrogen and progesterone, it may cause hot flashes, night sweats, and decreased bone mineral density (a marker indicating bone loss) that can predispose women to bone fractures. In theory, the add-back therapy might decrease the risk of hot flashes, night sweats, and bone loss.

For women taking elagolix with add-back therapy, the researchers found that by the end of 12 months:

  • Nearly 90% of women had less blood loss during their period; compared with their blood loss before starting the medicine, these women experienced at least a 50% reduction in blood loss.
  • 64% of women on elagolix with add-back therapy did not get a period at all.
  • Among women who were anemic at the beginning of the study period, nearly 73% showed a statistically significant improvement in their blood count.
  • The size of the uterus also decreased, although the size of the fibroids did not.

The most common side effects in both groups were hot flashes and headaches. Severe side effects were rare. However, compared with women taking only elagolix, women on elagolix with add-back therapy had fewer and less severe hot flashes and night sweats, and experienced much less loss of bone mineral density (although both groups demonstrated bone loss).

Based on a questionnaire given to both groups, women taking elagolix with add-back therapy reported a better quality of life.

Who might find this new option helpful?

This new FDA-approved medication could potentially be an excellent option for women who would like to avoid surgery and try medical management of their fibroids instead. The caveat is that the trial studied this drug for 12 months. The FDA has not approved its use for more than 24 months, so this may not be a lifelong solution for patients.

However, elagolix with add-back therapy could be an excellent option for women who are perimenopausal, will likely go through menopause in one to two years, and want to avoid a hysterectomy. It would also be an excellent option for women who are interested in conceiving in one to two years, and would like to decrease menstrual bleeding without resorting to surgery.

Women seeking long-lasting relief from heavy menstrual bleeding due to fibroids have long been told that their best option is a hysterectomy. This new data may have the potential to change that advice.

The post Can a daily pill lighten heavy menstrual bleeding caused by fibroids? appeared first on Harvard Health Blog.

Source : Harvard Health More   

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WHO Experts in China to Begin Investigation of Coronavirus Origins

The last WHO coronavirus-specific mission to China was in February, after which the team’s leader, Canadian doctor Bruce Aylward, praised China’s containment efforts and information-sharing

WHO Experts in China to Begin Investigation of Coronavirus Origins

(BEIJING) — Two World Health Organization experts will spend the next two days in the Chinese capital to lay the groundwork for a larger mission to investigate the origins of the COVID-19 pandemic.

An animal health expert and an epidemiologist will meet Chinese counterparts in Beijing on Saturday and Sunday to fix the “scope and terms of reference” for a WHO-led international mission aimed at learning how the virus jumped from animals to humans, an agency statement said.

Scientists believe the virus may have originated in bats, then was transmitted through another mammal such as a civet cat or an armadillo-like pangolin before being passed on to people.

A cluster of infections late last year focused initial attention on a fresh food market in the central Chinese city of Wuhan, but the discovery of earlier cases suggests the animal-to-human jump may have happened elsewhere.

In an effort to block future outbreaks, China has cracked down on the trade in wildlife and closed some markets, while enforcing strict containment measures appear to have virtually stopped new local infections.

The WHO mission is politically sensitive, with the U.S. — the top funder of the U.N. body — moving to cut ties with it over allegations the agency mishandled the outbreak and is biased toward China.

More than 120 nations called for an investigation into the origins of the virus at the World Health Assembly in May. China has insisted that WHO lead the investigation and for it to wait until the pandemic is brought under control. The U.S., Brazil and India are continuing to see an increasing number of cases.

The last WHO coronavirus-specific mission to China was in February, after which the team’s leader, Canadian doctor Bruce Aylward, praised China’s containment efforts and information-sharing. Canadian and American officials have since criticized him as being too lenient on China.

An Associated Press investigation showed that In January, WHO officials were privately frustrated over the lack of transparency and access in China, according to internal audio recordings. Complaints included that China delayed releasing the genetic map, or genome, of the virus for more than a week after three different government labs had fully decoded the information.

Privately, top WHO leaders complained in meetings the week of Jan. 6 that China was not sharing enough data to assess how effectively the virus spread between people or what risk it posed to the rest of the world, costing valuable time.

Source : Time More   

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