Presurgical treatment of uterine myomas with the GnRH-antagonist relugolix in combination therapy: an observational study

To evaluate if a preoperative medical treatment with the GnRH-antagonist relugolix in combination therapy in a series of patients with abnormal uterine bleeding associated with uterine myomas may correct the anemia before scheduled surgery for myoma-associated AUB. Thirty-one patients scheduled for surgery underwent a pre-operative three-month course with a daily oral tablet of 40 mg relugolix, 1 mg estradiol, and 0.5 mg norethindrone acetate. Hemoglobin levels, uterine volumes, largest myoma diameter, and VAS score for dysmenorrhea, pelvic pressure and bleeding discomfort, and indication to surgery were evaluated at study enrollment and at the end of therapy. Mean hemoglobin levels increased by 25%, from 9.3 +/- 1.1 to 11.6 +/- 1.7 g/dL after three months (p < 0.001). Uterine volume decreased from 380.7 +/- 273.4 mL to 281.7 +/- 198.7 mL (p < 0.001), whereas the diameter of the largest myoma decreased from 6.4 +/- 2.8 cm to 5.5 +/- 2.2 cm (p < 0.001). Four patients (13%), initially planned for a laparotomy procedure, were converted to a minimally-access procedure, whereas in eight patients (26%) surgery was avoided after medical therapy. Dysmenorrhea score improved from 4.7 +/- 3.2 to 0.6 +/- 1.1 (p < 0.0001). Pelvic pressure score decreased from 5.9 +/- 2.1 to 3.1 +/- 2.3 (p < 0.0001), whereas bleeding discomfort decreased from 7.4 +/- 3.0 to 0.4 +/- 1.6 (p < 0.0001). Preoperative GnRH-antagonist therapy may enhance hemoglobin levels, decrease uterine and myoma size, and alleviate symptoms, potentially enabling safe surgical procedures.