GnRH antagonists for the treatment of fibroids and adenomyosis, current evidence and future perspectives

Ferrero S, Simone Ferrero, Irene Gazzo, Gazzo I, Perrone U, Umberto Perrone, Francesca Olcese, Olcese F, Ottonello S, Silvia Ottonello, Rosato FP, Francesco Paolo Rosato, Vellone VG, Valerio Gaetano Vellone, Barra F, Fabio Barra
Expert opinion on pharmacotherapy · 2026 · vol. 27(11) , pp. 1163–1178 · doi:10.1080/14656566.2026.2695094 · PMID:42360331 · W7166140214
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GnRH antagonists effectively treat uterine fibroids by suppressing heavy menstrual bleeding and show promise for adenomyosis, though symptoms may recur upon discontinuation.

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Abstract

INTRODUCTION: Uterine fibroids and adenomyosis are common estrogen- and progesterone-dependent disorders associated with heavy menstrual bleeding, pelvic pain, anemia, and impaired quality of life. Although surgery remains widely used, there is an increasing demand for effective uterus-preserving medical therapies. Oral gonadotropin-releasing hormone (GnRH) antagonists have recently emerged as a novel therapeutic option, allowing rapid, reversible, and dose-dependent suppression of ovarian steroidogenesis. AREAS COVERED: This narrative, based on a targeted PubMed/MEDLINE literature search and review of major guideline documents published up to May 2026, summarizes the pharmacological properties, mechanisms of action, and clinical evidence regarding GnRH antagonists (elagolix, relugolix and linzagolix) in uterine fibroids and adenomyosis. Evidence from randomized controlled, extension studies, and emerging literature was critically reviewed, focusing on control of heavy menstrual bleeding, pain reduction, quality of life, safety, and the role of add-back therapy. EXPERT OPINION: GnRH antagonists represent a major advance in the medical treatment of uterine fibroids and are highly effective in controlling heavy menstrual bleeding. Their role in adenomyosis appears promising, although evidence remains limited. These agents should currently be considered suppressive rather than curative therapies, as symptoms often recur after discontinuation. Long-term integration into individualized treatment strategies will require further safety and comparative effectiveness data.

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MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (83)

SciLite annotations

chemicals 3
estrogen progesterone elagolix

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