Medical treatment of fibroids: FIGO best practice guidance

Even though uterine fibroids are a widespread condition, the range of approved medical treatment options remains limited. In fact, only a few drugs are officially approved for the therapy of fibroids. In both the USA and the European Medicines Agency region, selected gonadotropin-releasing hormone (GnRH) antagonists have been approved for this indication. GnRH analogs are primarily indicated for the preoperative management of uterine fibroids, largely because of their unfavorable long-term adverse effect profile. The previously approved therapy with ulipristal acetate had to undergo extensive restrictions because of safety concerns. Nevertheless, there are additional medications that may be used in clinical practice. These include combined oral contraceptives, oral progestins, the levonorgestrel-releasing intrauterine system (LNG-IUS), and tranexamic acid. Although not specifically approved for the treatment of fibroids, these agents can reduce the intensity of bleeding in cases of heavy menstrual bleeding and thereby improve symptoms and lead to an improved quality of life for the patients.