In the previous weeks, we’ve dug deeper into the use of Gonadotropin-releasing hormone (GnRH) agonists, and birth control in treating fibroid symptoms. This week, we’re going to look at a combination therapy that was recently approved by the FDA for the treatment of heavy bleeding caused by uterine fibroids called Oriahnn.
Oriahnn is a prescription drug, that has been created by combining three different oral therapies. These include a gonadotropin-releasing hormone (GnRH) agonist and two hormones: estradiol (a form of estrogen), and norethindrone acetate (a form of progestin).
The GnRH agonist in Oriahnn is elagolix, which causes a decrease in estrogen and progesterone levels in the body. The decrease in these hormones causes a temporary menopause-like state which reduces the size of the fibroids and the size of the uterus. It also inhibits menstruation, thus enabling women with bleeding-induced anemia, to increase their stores of iron. GnRH agonists can also improve fibroid-related symptoms such as frequent urination and constipation.
One of the problems with GnRH agonists is that the decrease in estrogen caused by them can lead to an increased risk of osteoporosis. Osteoporosis is a disease that weakens the bones, thus putting them at a greater risk for sudden and unexpected bone fractures. Since estrogens play a central role in the homeostasis of the skeleton, estrogen deficiency seems to be primarily responsible for the adverse skeletal effects of GnRH agonists. As a result of the estrogen decrease caused by GnRH therapy, bone turnover can increase while bone mineral density can decrease, thereby increasing the risk of fractures.
This is where the addition of estradiol and norethindrone comes in.
Estradiol is a type of estrogen hormone used by women to help reduce the symptoms of menopause. And, in the case of treating fibroids, it helps to prevent the bone loss that can be caused by using a GnRH agonist alone.
Norethindrone is a progestin hormone. The addition of this hormone helps to inhibit estrogen-related fibroid growth and therefore helps to keep the fibroids from growing.
Studies have found that Oriahnn is effective in reducing fibroid-related heavy menstrual periods. The combination of GnRH agonist, estradiol, and norethindrone has proven to be effective with a lower risk of adverse problems than can come from GnRH agonists alone. However, when it comes to eliminating fibroids completely- this medication can not achieve that outcome.
Here are some of the pros and cons associated with this new medication:
Pros:
Works to lighten heavy periods for a majority (7 out of 10) of women
Can reduce period bleeding by 50% after 1 month
Non-surgical treatment option for uterine fibroids
Can take with or without food
Cons:
Treatment is limited to 24 months because of the risk of permanent bone loss
Unknown if it’s safe or works for children under 18 years of age
Interacts with many medications
No generic available, so it might be expensive
Needs to be taken twice a day
The bottom line: The FDA’s most recent approval of the medication Oriahnn to control heavy bleeding in women with uterine fibroids, is potentially a better medicine than a GnRH agonist alone- but it is not without its problems. Oriahnn is not recommended for long-term use and it doesn’t eliminate fibroids. In order to shrink or eliminate fibroids, a non-invasive procedure such as Uterine Fibroid Embolization, or sometimes surgery is usually the best choice.
Next week we will wrap up our look at oral therapies used to treat uterine fibroid symptoms, by looking at the use of Tranexamic Acid to reduce fibroid-related bleeding.
