The use of progesterone-like synthetic hormones known as progestins has been common for many years.  Mostly this class of drug has been used to control heavy periods on a short-term basis, the heavy period that some women experience with uterine tumors.  However, long-term use of various forms of these hormones may be beneficial for not only control of bleeding, but may also bring about reduction in the size of the tumors themselves. 

Several years ago I saw a woman for evaluation of extremely large fibroids and very heavy bleeding. At the time that I originally saw her, she was severely anemic, very pale in appearance and complaining of general fatigue because of the severity of her anemia.  Her uterus was approximately the size of a seven-month pregnancy.  She had periods that were so heavy that she had to remain in the house for at least five days out of each month.  She had been hospitalized on at least one occasion for emergency control of her bleeding.  Hysterectomy had been recommended to her and she wished to pursue other alternatives.  Complicating matters even more was the fact that she was extremely phobic, terrified not only of the potential for having to undergo major surgery but also was afraid of being admitted to a hospital for any reason.  To control her bleeding she was placed on a form of progestin called megestrol acetate.  This is taken in tablet form and was administered four times a day over the next two years.  In that time period not only was her heavy bleeding controlled, but the size of her uterus shrank from the seven month pregnancy size to something closer to approximately a four and a half month pregnancy size representing at least a 50% decrease in size.  Because of the decrease in her period, her anemia was completely resolved and her energy levels returned to normal. 

Another more dramatic example of how the progestin’s can be useful occurred approximately ten years ago when I saw a 45-year-old woman from upstate New York.  This patient gave a dramatic history of extremely heavy periods associated with anemia.  Her uterus was the size of an eight-month pregnancy.  Her condition was complicated by the fact that she had diabetes, high blood pressure and lung disease.  She was an extremely poor candidate for any form of surgery.  Over a five year time period we treated her with high dose progestin’s; first, by injection and subsequently, in tablet form.  This controlled her bleeding long enough to allow her to enter menopause without any further need for surgery. 

Avoiding surgery for this woman was a significant benefit.  Because of her multiple medical conditions, she was a poor candidate for any major form of surgery and could have experienced substantial complications, including death, had surgery been performed. 

Although the progestin’s can be very useful in controlling symptoms, many women are not happy using them in the high dose form over time.  This is because for these drugs to cause side effects such as, swelling, weight gain, depression, and vaginal dryness.   As a consequence, progestin’s often are useful only as a temporary measure until it is convenient to utilize other modes of therapy.

Paradoxically, it is now known that progesterone as well as estrogen is responsible for fibroid growth. Most often the synthetic progestins do not share this same characteristic.  But occasionally some women will experience stimulation of fibroid growth.  -  Francis L. Hutchins, Jr., M.D.