Journal of the European Society for Gynaecological Endoscopy


Use of oral GnRH antagonists combined therapy in the management of symptomatic uterine fibroids

A. Di Spiezio Sardo1, F. Ciccarone2, L. Muzii3, G. Scambia2, M. Vignali4

1 Department of Public Health, School of Medicine, University of Naples Federico II, Via Pansini 5, Naples, Italy
2 Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
3 Department of Mother, Child and Urological Sciences, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
4 Department of Biomedical Sciences for Health, University of Milan, Macedonio Melloni Hospital, Via Macedonio Melloni 52, 20129, Milan, Italy


Uterine fibroids, GnRH antagonists, epidemiology, Relugolix

Published online: Mar 30 2023


Uterine fibroids have an impact on women’s lives due to their high prevalence, physical symptoms, their consequences on patients’ emotional and psychological well-being and loss of work productivity.

The choice of therapeutical approaches varies depending on several factors, and therefore should be applied individually. Currently, there is an unmet need for good, reliable, uterine-sparing options.

The oral GnRH antagonists (Elagolix, Relugolix, Linzagolix) represent a new alternative for the medical management of hormone-dependent gynaecological diseases such as uterine fibroids or endometriosis. They rapidly bind to the GnRH receptor, block endogenous GnRH activity and directly suppress LH and FSH production, avoiding unwanted flare-up effects.

Some GnRH antagonists are marketed in combination with hormone replacement therapy add-back to counteract hypo-oestrogenic side effects. According to the registration trials, once-daily GhRH antagonist combination therapy results in a significant reduction in menstrual bleeding, as compared with placebo, and preserves bone mineral density, for up to 104 weeks. Further studies in the long term are needed to evaluate the whole impact of medical treatment of uterine fibroids on the management of this common women’s disease.