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Oral pill that shrinks fibroids linked to serious liver injury

Dr Eisen Liang - Monday, August 20, 2018

Oral pill that shrinks fibroids linked to serious liver injury

What’s the next best non-surgical option?  

For women suffering from fibroids (non-cancerous tumors), every day could be a physical and emotional agony. And many of these women don’t want to go under the knife just to take out their fibroids or lose their uterus for a lot of reasons. This is why nonsurgical approaches to treating fibroids make it a reasonable alternative for women.

Among the few nonsurgical options available, taking oral medication to shrink fibroids could just be the easiest and most convenient treatment there is. Recently, a new fibroid-shrinking drug called ulipristal acetate under the brand name Esmya® has been made available to patients with a promising efficacy to remove the need for future surgical fibroid treatment. However, Esmya was removed from the market following safety concerns regarding liver toxicity requiring transplantation.

Regulators from the European Medicines Agency’s (EMA) are currently reviewing the benefits and risks of Esmya usage and have advised patients and healthcare providers to follow specific temporary safety measures to minimize potential risks to patients.

In the meantime, the EMA has recommended healthcare professionals to refrain from using Esmya to treat new patients and those who have already finished previous treatments with the said pill.

As for women who are currently taking Esmya for uterine fibroids, they are advised to monitor their liver function at least once a month during treatment. If they ever experience symptoms related to liver problems like nausea, vomiting, yellowing skin/eyes, anorexia, weakness, and/or upper abdominal pain, they must stop treatment and seek medical help right away. Liver tests are also highly advised to be repeated 2-4 weeks after stopping treatment.

With this impending health and safety risk and concern, what could be the best treatment for fibroids? In the past, the only possible options involved major surgeries such as removal of fibroids (myomectomy) and removal of the whole uterus (hysterectomy). These treatments require general anaesthetics, longer hospital stay and recovery period, and a higher risk of complications compared with today’s available non-surgical treatments.

One non-surgical treatment option is uterine fibroid embolization (UFE), which shrinks fibroids by placing tiny “plastic” particles into the artery that feeds the fibroids. This blocks the blood supply of fibroids, leading them to shrink. The procedure is relatively simple and minimally invasive, performed under local anesthetic, requiring 1-night stay in the hospital and 1-week recovery.

Want to learn more about fibroids and UFE? Visit our website at for more information.


Dr Eisen Liang is an interventional radiologist with special interest in gynaecological intervention such as Uterine Fibroid Embolisation (UFE), adenomyosis embolisation and ovarian vein embolisation for pelvic congestion syndrome. He performed his first UFE in 1998 and has been performing UFE at Sydney Adventist Hospital since 2007.
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