Home Top

show ad

Home Top

Joe Biden's son Beau dies aged 46 after battle with brain cancer: Vice President mourns 'the finest man any of us have ever known'
Physically abused, told they would die at 12 and banned from school: 'Real-life Kimmy Schmidt' twins reveal what life was like inside controversial Children of God sect
Saudi Arabian billionaire buying New York City's highest luxury penthouse for $95MILLION
'He doesn't eat pizza': Lawyer claims suspect accused of holding captive and murdering DC family is innocent and not 'capable of killing anybody'
Not tonight Napoleon! New documentary claims it was Josephine who spurned him - and had affairs with 'less needy' lovers
Cops end up shooting dead man they were trying to rescue from rising flood waters
My own brother destroyed Amy: He watched his big brother Blake pull Amy Winehouse into the squalid depths of heroin addiction. Harry Civil lifts the lid on toxic marriage that ripped his family apart
NSA's bulk collection of phone records is set to end today as Rand Paul vows to block reform of the Patriot Act
Muslim passenger on United Airlines flight 'told she can't have unopened Diet Coke in case she uses the can as a WEAPON'
'Ferguson Effect': Commentators claim 'criminals are feeling empowered' as police back off after months of protest and violent crime rises
Police are shooting dead an average of two people a day this year - double the rate of fatal shootings over the past decade
Texas floods death toll rises to 31 as two more bodies are found and SNAKE bites soar - as thousands of the reptiles flee soaked ground for populated areas
Jim Bob and Michelle Duggar will appear with Megyn Kelly to address molestation allegations and share about the 'tears we all shed and the forgiveness that was given'
How FIFA were nailed by last act of revenge of a dying man: Investigative journalist ANDREW JENNINGS reveals how former official led him and the Feds into the dirty depths of Blatter's kingdom of corruption
Former Maryland Governor O'Malley launches White House bid
Is sex hormone testosterone to blame for corrupting world leaders? New study reveals surprising science behind corruption and power
'It's a perfect match!' Hooters waitress donates kidney to regular customer
Controversial 'Are you beach body ready?' weight loss advert that provoked angry protests in London arrives in New York
What's your dog trying to tell YOU? Scientists discover animals' bark can reveal whether it is scared or lonely...and can even be used to tell its gender and age
US swimming pools to ban prolonged under water breath-holding
Government paid $20.2 million in Social Security benefits to more than 130 ex-Nazis who went on to live comfortably in the U.S.
'There's going to be one killer blues session in heaven tonight': B.B. King's family come together to lay him to rest in moving funeral service with tribute from President Obama
At least four Americans are being held hostage in Yemen by rebels who toppled government
Christian Syrian fighter BEHEADS ISIS prisoner in revenge for the group's atrocities after discovering he was a member of Islamic State

Revolutionary drug to shrink fibroids could spare women hysterectomies

By Cara Lee for the Daily Mail

Published: 19:37 EST, 3 March 2014 | Updated: 19:37 EST, 3 March 2014

View
comments

Katherine, 43, had fibroids and used a new treatment to reduce pain and heavy bleeding, and shrink theM

Waking up in agony, Katherine Hill knew instantly what was causing the pain in her lower abdomen.

The 43-year-old children's nurse, like 40 per cent of women, had fibroids. These are benign growths that develop in or around the uterus, and Katherine was unfortunately familiar with the symptoms - five years earlier she'd undergone surgery to have a large fibroid removed.

She'd initially been referred to a gynaecologist after blood tests showed she was iron deficient, which her GP had put down to heavy periods.

'I'd always presumed my heavy periods were normal, but at that time they seemed to last longer and were heavier than before,' says Katherine, who lives with her husband Graham, 43, a shop owner, in Nottingham.

Fibroids can make the surface area of the womb lining, the endometrium, increase - when this is shed each month, this causes heavier bleeding. After her surgery, Katherine's symptoms dramatically improved.

Then, two years ago, she started experiencing pain so bad it woke her at night. Initially, Katherine tried to manage the pain, which occurred during the first three days of each period, with painkillers and hot-water bottles, to little avail. She was also experiencing heavy bleeding again, causing embarrassing leaks.

After six months of symptoms she saw her gynaecologist. An ultrasound revealed a large 6cm fibroid, and one smaller fibroid.

She was prescribed tranexamic acid, commonly used to tackle heavy periods - it promotes blood clotting. When this didn't work, he suggested a new daily pill, Esmya.

The drug was licensed in 2012 as a three-month treatment for fibroids before surgery to remove them - it reduces their size.

Research published in the New England Journal of Medicine showed that Esmya quickly controlled bleeding in 90 per cent of patients and significantly reduced fibroid size; in patients who didn't later have the fibroids removed, this reduction lasted up to six months.

The drug has now been approved for use for a further three months, if the woman needs it, with a gap of two menstrual cycles between. Researchers are assessing whether Esmya can be used longer term.

After starting on the drug last spring, Katherine found that the bleeding and pain she had suffered quickly stopped.

'Not waking in the middle of the night with pain was a godsend. I felt confident doing everyday activities,' she says.

Katherine was prescribed tranexamic acid, commonly used to tackle heavy periods - it promotes blood clotting

While the exact cause of fibroids is unknown, the hormones oestrogen and progesterone are thought to sustain them once they start growing.

Esmya effectively blocks the progesterone receptors in fibroids and the endometrium. As well as stopping the fibroids growing, this causes them to shrink, stopping heavy bleeding and pain. In many women, periods get much lighter or stop; they return around six weeks after treatment stops.

'Esmya is a significant breakthrough,' says Professor Ellis Downes, a consultant gynaecologist at the Portland Hospital, London. 'From my experience, and from the published studies, after three months on Esmya, fibroids shrink by an average of 50 per cent, it gets rid of symptoms and serious side-effects are uncommon.'

Treatment is only necessary if women experience symptoms from fibroids, as many have them without realising and there is no risk if symptomless fibroids remain in the body, he explains.

Symptoms include heavy periods and anaemia, pelvic pain, infertility and discomfort during sex. If the fibroids grow towards the abdomen, they become big lumps and can make women look pregnant, and press on the bladder or bowel causing them to need the loo more. They can also lead to back pain.

Some patients need an operation even if the fibroid has shrunk, if symptoms return, but Professor Downes says fewer than 25 per cent of his patients needed surgery. 'Those who did still benefited from Esmya; they lost less blood and the fibroid was smaller and therefore easier to remove.'

After starting on the drug last spring, Katherine found that the bleeding and pain she had suffered quickly stopped

Indeed, a few weeks after Katherine stopped taking Esmya, her heavy periods returned so her largest fibroid was removed. It had shrunk by a third, so the operation was more straightforward.

Fibroids naturally have a rich blood supply, so there can be too much bleeding to carry out surgery accurately and operations may need to be stopped prematurely, says Martin Powell, Katherine's consultant gynaecologist at Nottingham University NHS Trust (who is part of a multi-centre European study looking into the drug).

Esmya has potential side-effects, however. It can thicken the womb lining - a condition known as endometrial hyperplasia, which is associated with a slightly higher risk of womb cancer. Studies suggest this returns to normal after the three-month course.

Other side-effects may include bleeding, ovarian cysts, pelvic pain and breast tenderness.

The main risk factor for fibroids is a family history; women of Afro-Caribbean descent are also more likely to develop them, says Mr Powell. Typically, women aged 30 to 50 are affected. Because fibroids are linked to oestrogen, some women choose not to have them surgically removed and wait until they reach the menopause, when oestrogen falls naturally and the fibroids slowly shrink.

But many seek a faster solution.

An alternative drug to Esmya is gonadotrophin-releasing hormone (GnRH) agonists, which reduce oestrogen and progesterone levels to achieve a temporary post-menopausal state.

Given as monthly injections, these stop the pituitary gland in the brain releasing luteinising hormone and follicle-stimulating hormone, which make the ovaries produce oestrogen and progesterone.

14lb

The weight of the largest fibroid ever removed

However, this treatment can be used for only six months as it can cause loss of bone density (oestrogen helps to keep bones strong).

'Patients don't like these drugs because they cause unpleasant menopausal symptoms such as hot flushes and when stopped, the fibroid problem returns,' says Dr Woodruff Walker, a consultant diagnostic and interventional radiologist at the Royal Surrey County Hospital in Guildford.

Esmya treats fibroids without surgery 'equally well, but without the side-effects associated with reduced oestrogen', adds Professor Downes. 'Rate of regrowth is less than after the conventional injection treatment.'

There is little difference in cost - Esmya costs £300 for three months, while the injections would be £250 in that time-frame.

However, Dr Walker believes that rather than being a long-term treatment, Esmya may only have a role in temporarily relieving symptoms before more definitive measures are required, and says it doesn't work in all women.

Fibroids naturally have a rich blood supply, so there can be too much bleeding to carry out surgery

He believes fibroid embolisation, in which he specialises, is superior to drug treatments and open surgery such as hysterectomy.

This minimally invasive procedure uses X-ray to guide a tube inserted via the groin to the arteries in the uterus. Tiny plastic balls are then injected to block the blood supply to the fibroids, killing them. The dead fibroids shrinks over three to six months.

'This works in more than 90 per cent of cases,' he says. However, embolisation is difficult for fibroids inside the uterus.

Another treatment uses MRI to focus ultrasound beams on to the fibroid, encouraging it to shrink, but this is not widely available due to expense.

Despite these options, it's thought that 30,000 British women with fibroids still have hysterectomies - a complete removal of the womb - each year. Experts feel this is unwarranted major surgery, which leaves women infertile.

'In nearly all cases, hysterectomy is unnecessary,' says Dr Walker.

Hysterectomies carry a 4-6 per cent risk of serious complications, such as damaging the bladder or bowel, or vaginal prolapse. The risk of death is around one in 1,000, higher than other, less invasive, surgeries.

Embolisation has a 0.5 per cent risk of ovarian failure and early menopause.