The Uterine Fibroid Treatment and Telemedicine Landscape

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Erica Marsh, MD, MSCI, discusses the role of new drug classes like GnRH antagonists, as well as the adoption of remote screening options following COVID-19 response.

The field of uterine fibroid care has been stable for a long period of time, but advances in screening, referral and pharmacotherapy options are occurring all the same.

In the second segment of an interview with HCPLive, Erica Marsh, MD, MSCI, professor of Obstetrics and Gynecology at University of Michigan Medical School, discussed the current state of therapy options for fibroids. Beyond the recent development and regulation fo gonadotropin-releasing hormone (GnRH) antagonist therapies, treatments are fairly straightforward—and directed toward symptom management.

Marsh discussed the range of options, from observation to simple medical therapies including non-steroidal anti-inflammatory drugs (NSAIDs) and intrauterine devices, to radiological and even surgical options including myomectomies and hysterectomies. While some research has looked into the benefit of vitamin D, green tea extract, red wine and other common exposures, few have shown clear clinical benefit.

Rather, it’s important for patients with fibroids to understand the variation, potential, and limitation of available treatments, Marsh explained.

“It’s important that patients to hear about all those options and understand, given their goals and intentions—particularly, do you want to retain the ability to carry a pregnancy in the future, or is it important for you to keep your uterus?” Marsh said.

Lastly, Marsh reviewed the state of referral, screening, imaging and elective surgery for fibroids as it related to the COVID-19 pandemic response in the US. She noted that delays in elective invasive care have essentially stopped, and the field has returned to some normalcy—with the caveat of a few key additions such as bolstered imagine and telemedicine appointments that have made the progression from screening to treatment more fluent.

“I think we have gotten creative and thoughtful, thinking outside the box in the setting of COVID,” Marsh said. “What that’s has led to is, how can we help patients who may not live 20-30 minutes away, who may live 4 hours away and don’t have the same options that can be provided at larger health care system?”