Medical management can sometimes help women with symptomatic fibroids, heavy bleeding, or endometriosis to avoid hysterectomy. In other cases it can serve to minimize the impact of surgery. Options include various types of oral contraceptives, progesterone/progestin hormones, and GnRH agonists.

For some women, certain forms of The Pill work well. The synthetic progestin component can sometimes offset the stimulating effect of her own estrogen, but not always since The Pill also contains synthetic estrogens.

Another option is the Mirena intrauterine system (IUS), which releases a synthetic progestin inside the uterus. It’s available as birth control, but can also help control bleeding issues and prevent the need for hysterectomy in some women.

We suggest women try to use natural progesterone products for these purposes whenever possible, such as Prometrium prescription capsules or custom-compounded micronized progesterone products. If contraception is also needed, The Pill and Mirena are reasonable to consider.

Lupron is a type of GnRH agonist. GnRH agonist drugs are modified versions of the naturally occurring hormone known as gonadotropin releasing hormone, which plays a role in regulating the menstrual cycle. Lupron and other GnRH agonists are prescribed to bring on a sudden, temporary "medical menopause" in an attempt to shrink fibroids or reduce endometrial implants. They are usually used preoperatively to improve ease of surgery.

Lupron inhibits ovarian function and severely decreases a woman’s estrogen and hormone production as well, creating some unfortunate side effects, including instant menopausal symptoms and potentially serious bone thinning. Women usually use the drug for 3–6 months, then evaluate how the symptoms have improved. Often they do go on to have surgery.