Uterine fibroid therapy reference (2026)

Uterine fibroid therapy in 2026 organises around three tiers.

Medical: oral GnRH antagonist plus add-back hormone combinations (relugolix combination, elagolix combination) provide menstrual bleeding and pain control. Tranexamic acid for heavy menstrual bleeding and combined hormonal contraception for symptom management remain in routine use. NSAIDs for symptomatic management.

Procedural (uterine-preserving): uterine artery embolisation, transcervical radiofrequency ablation, magnetic resonance-guided focused ultrasound, hysteroscopic myomectomy for submucosal fibroids, laparoscopic or robotic myomectomy for intramural and subserosal fibroids.

Surgical (definitive): hysterectomy remains the most common definitive treatment and is the right choice for patients who have completed childbearing and prefer single-procedure resolution.

The decision among medical, procedural, and surgical options depends heavily on fertility intentions, fibroid characteristics (size, location, number), and patient preference. Integrated care models that present the full option set to patients (rather than channeling toward the option the proceduralist most commonly performs) are increasingly recognised as the right standard.