It’s time to make a change from a lesion-tailored to a patient-tailored approach in the management of uterine fibroids

Abstract

The management of patients with uterine fibroids (UF) has changed substantially during the last century thanks to the development of new drugs focused on symptom management.The burden of UF on women's lives is significant for the severity of the symptoms (mainly heavy menstrual bleeding, pain, bulk symptoms and even impaired fertility) that can negatively affect their quality of life from a personal, familiar and professional point of view. The current approach should take into account all women's needs, their daily problems and their fears and expectations, shifting from a lesion-oriented vision to a patient-oriented one.The new tools for the medical management of UF currently available, the oral GnRH antagonists with add-back therapy (ABT), allow great flexibility with safe options.Relugolix Combination Therapy (40mg Relugolix + 1mg oestradiol hemihydrate + 0.5mg norethisterone acetate), one tablet daily, is licensed for the treatment of moderate to severe symptoms of UF in adult women of reproductive age. The triple combination has the aim of combining preventive activity on the growth of UF with the maintenance of oestradiol and progesterone levels in an optimal therapeutic range, in order to minimize the adverse effects. In the phase 3 double-blind trials, Relugolix CT producing oestradiol concentrations of 33 pg/ml, as in the early follicular phase within the therapeutic window, represents a balanced long-term treatment.In a new holistic, patient-oriented approach, the ability of Relugolix CT to improve the most common and troublesome symptoms associated with UF and related distress, has significant clinical and socio-economic implications.

Use of oral GnRH antagonists combined therapy in the management of symptomatic uterine fibroids

“…Consideration is given not only to the costs/benefits and advantages/ disadvantages in the short term, but also and more importantly, in the medium and long term, especially when considering the morbidity and mortality rates for each surgical procedure and, to a lesser extent, medical treatment. The criteria vary in relation to several different factors, and thus the different approaches must be applied to the individual clinical case, in a perspective scenario ( Conoscenti et al, 2017 ; Di Spiezio et al, 2019 ). Currently available medical therapies, radiological interventions and surgical strategies are described in Table I .…”