Insights on Medical Therapy for Uterine Fibroids: A Review

Uterine fibroids constitute the most prevalent benign neoplasms within the female reproductive system, impacting a substantial proportion of women by the age of 50 years. While a significant number of these tumors remain asymptomatic, they have the potential to induce abnormal uterine bleeding (AUB), pelvic discomfort, pain, anemia, and infertility, thereby considerably diminishing the quality of life. Pharmacological intervention occupies a pivotal position in the management of fibroids, particularly for individuals who desire to preserve uterine function, postpone surgical intervention, or opt for noninvasive alternatives. Over the preceding two decades, the landscape of medical treatment has undergone significant expansion. Conventional therapeutic options, such as GnRH agonists and hormonal contraceptives, continue to be beneficial in specific contexts; however, their limitations regarding tolerability, skeletal safety, and sustained efficacy are widely acknowledged. Oral GnRH antagonists, which include elagolix, relugolix, and linzagolix, signify a substantial progression, providing rapid and reversible suppression of ovarian hormone synthesis with dose-dependent effects and enhanced convenience. Clinical investigations demonstrated substantial reductions in excessive menstrual bleeding, enhancements in anemia, and improvements in quality of life associated with these pharmacological agents, particularly when administered in conjunction with hormonal add-back therapy. Alternative interventions, including selective progesterone receptor modulators (SPRMs), progestins, aromatase inhibitors, and antifibrinolytics, exhibit variable effectiveness and are optimally utilized within defined clinical frameworks. Concerns regarding safety, especially in relation to hepatic toxicity associated with SPRMs, have prompted regulatory limitations and underscore the necessity for ongoing pharmacovigilance. Tailored therapeutic approaches that consider reproductive objectives, symptomatology, comorbid conditions, and patient preferences are of paramount importance. Innovative treatment modalities that target nonhormonal mechanisms, such as extracellular matrix remodeling, angiogenesis, and gene modulation, provide promising prospects for future uterus-sparing interventions. This narrative review evaluates the current and advancing landscape of medical therapies for uterine fibroids, presenting evidence-based perspectives to inform clinical decision-making within an increasingly personalized therapeutic context.