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

A Di Spiezio Sardo, F Ciccarone, Francesca Ciccarone, L Muzii, Giovanni Scambia, G Scambia, M Vignali
Facts, views & vision in ObGyn · 2023 · vol. 15(1) , pp. 29–33 · doi:10.52054/fvvo.15.1.059 · PMID:37010332 · PMC10392112 · W4362473297
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

Oral GnRH antagonists combined with hormone therapy significantly reduce uterine fibroid bleeding and preserve bone density without a flare-up effect.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

The paper reviews the rationale and evidence for using oral GnRH antagonists—elagolix, relugolix, and linzagolix—combined with hormone replacement therapy add-back to manage symptomatic uterine fibroids while aiming for uterine-sparing treatment. It describes how these antagonists rapidly bind the GnRH receptor to suppress LH/FSH without flare effects, and cites registration trial findings that once-daily combination therapy significantly reduces menstrual bleeding versus placebo and preserves bone mineral density for up to 104 weeks. The major caveat stated is that further long-term studies are needed to evaluate the overall impact of medical treatment for uterine fibroids. Relevance to endometriosis: the paper explicitly notes that oral GnRH antagonists are a new alternative for hormone-dependent gynecological diseases such as uterine fibroids or endometriosis, though its main focus is uterine fibroid management.

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Abstract

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.
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Abstract 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.

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endometriosis

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