Expert opinion on the use of GnRH antagonists ± ABT in the treatment of symptomatic uterine fibroids: real-life experience of Italian centres

ABSTRACT

Symptomatic uterine fibroids (UFs) are among the most common benign gynaecological conditions, significantly impacting women’s quality of life. Current guidelines favour a stepwise management strategy beginning with appropriately tailored medical therapy. More than five years after their introduction in Europe, oral GnRH antagonists with or without add-back therapy (ABT) have accumulated substantial real-world clinical experience, enabling to identify their use in different clinical situations.

In the short/medium term, GnRH antagonists ± ABT effectively control moderate-to-severe UF symptoms and can be used in synergy with surgery, while overcoming the flare-up effect and route-of-administration limitations associated with GnRH agonists.

In the long term, these combinations represent optimal solutions for various patient categories, maintaining a stable estrogenic threshold within the so-called therapeutic window. This approach controls estrogen-dependent conditions – including concomitant adenomyosis or endometriosis – while preserving bone health through adequate ABT, thus balancing efficacy and safety. Importantly, this treatment also improves women’s overall quality of life. In conclusion, GnRH antagonists ± ABT represent a versatile, personalized therapeutic option for women with symptomatic UFs across short, medium, and long-term clinical needs, supported by a well-established safety profile and a growing body of clinical evidence.

Key words

Uterine fibroids; medical therapy; drug combination; GnRH antagonists; relugolix; linzagolix.