Uterine Fibroids
Benign tumours of the uterine smooth muscle that can cause heavy bleeding, pain, and reproductive problems. Relugolix (combined with estradiol/norethindrone acetate) and elagolix are oral GnRH antagonists approved for fibroid symptom management.
Technical Context
Uterine fibroids (leiomyomas) are benign smooth muscle tumours affecting approximately 70% of women by age 50. They are oestrogen- and progesterone-responsive and regress after menopause. Symptoms: heavy menstrual bleeding (HMB — the most common indication for treatment), bulk symptoms (pelvic pressure, urinary frequency), pain, and reproductive complications. Medical management: relugolix combination tablet (Myfembree — relugolix 40mg + estradiol 1mg + norethindrone acetate 0.5mg daily — GnRH antagonist with hormonal add-back to manage menopausal symptoms and bone loss) and elagolix with add-back (Oriahnn — for HMB associated with fibroids). These oral GnRH antagonists represent a significant advance over injectable GnRH agonists for fibroids — offering convenient oral administration, dose-dependent oestrogen suppression, and built-in add-back therapy. Treatment duration: up to 24 months (bone density monitoring required).