Clinical Scenario

This protocol addresses uterine fibroids presenting with pelvic bulk or pressure symptoms — a presentation that warrants a targeted medical management strategy. Patients in this scenario may be offered hormonal agents that act on the gonadotropin-releasing hormone (GnRH) pathway.

Treatment Approach

Medical management centres on GnRH-based therapy, with both agonist and antagonist options available. The choice between approaches depends on individual patient factors, tolerability considerations, and clinical goals.

Full regimen details — specific agents, routes of administration, duration, and adjunct strategies — are available in the complete structured protocol.

Treatment Goals

The primary objectives are meaningful reduction in fibroid and uterine volume, with associated relief of bulk-related pressure symptoms. Clinically significant fibroid shrinkage can occur within the first months of therapy.

References

DOI: 10.1016/j.jogc.2025.102970

Patients with fibroids and bulk symptoms may be offered gonadotropin-releasing hormone agonists or antagonists.
Long term use of these agents may be limited by hypoestrogenic effects, though this may be mitigated by add-back hormone replacement therapy.
The use of GnRH agonist therapy has generally been used as a pre-operative adjunct, with duration of treatment limited to 3–6 months to shrink fibroids, reduce anemia related to uterine bleeding, and reduce surgical blood loss.
Presently, the GnRH antagonists available in Canada are elagolix and relugolix, and both have been found to be effective in the treatment of AUB associated with fibroids in randomized controlled trials.
In general, fibroids may be expected to shrink by up to 50% of their initial volume within 3 months of therapy.
Recent randomized controlled trials indicate that GnRH antagonists can be used for reducing menstrual bleeding in patients with fibroids, with decreased uterine volume, and improvement in quality of life in a dose-response manner.

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Treatment of Uterine Fibroids with Pelvic Bulk or Pressure Symptoms

References