{"doi":"10.1016/j.xfre.2022.11.008","title":"GnRH analogs for the treatment of heavy menstrual bleeding associated with uterine fibroids","abstract":"Treatment of heavy menstrual bleeding associated with uterine fibroids (UF) is evolving. Historically, treatment options were limited to predominantly invasive surgery; today, conservative and novel oral medical treatments are widely available for use with significant efficacy. This evolution was directly driven by our improved understanding of UF pathophysiology. Specifically, our recognition of the hormone-mediated pathway in UF development and growth laid the framework for using GnRH agonist analogs in treating UF. In this report, we explore the use of GnRH analogs in the treatment of heavy menstrual bleeding associated with UF in phases. We review historical perspectives, discuss the development and use of aternatives to GnRH analogs, a period we refer to as the “Dark Ages” of GnRH analogs, we then provide an overview of the later years and present-day use of GnRH analogs and discuss opportunities for future directions. Treatment of heavy menstrual bleeding associated with uterine fibroids (UF) is evolving. Historically, treatment options were limited to predominantly invasive surgery; today, conservative and novel oral medical treatments are widely available for use with significant efficacy. This evolution was directly driven by our improved understanding of UF pathophysiology. Specifically, our recognition of the hormone-mediated pathway in UF development and growth laid the framework for using GnRH agonist analogs in treating UF. In this report, we explore the use of GnRH analogs in the treatment of heavy menstrual bleeding associated with UF in phases. We review historical perspectives, discuss the development and use of aternatives to GnRH analogs, a period we refer to as the “Dark Ages” of GnRH analogs, we then provide an overview of the later years and present-day use of GnRH analogs and discuss opportunities for future directions. Archeologic evidence consisting of calcified masses found among human skeletal remains dating up to 5,000 years old supports the existence of uterine fibroids (UF) in the Neolithic period (1Kramar C. Baud C.A. Lagier R. Presumed calcified leiomyoma of the uterus. Morphologic and chemical studies of a calcified mass dating from the Neolithic period.Arch Pathol Lab Med. 1983; 107: 91-93PubMed Google Scholar). However, written documentation about individual experiences with UF dates back to Hippocrates, approximately 400 BC, when they were known as uterine stones. Over the years, this tumor earned many names—“scleroma,” “mole,” “mola,” and “fleshy tubercle.” In 1854, Dr. Virchow, a German pathologist, coined the name myoma, and in 1860, Rokitansky, a Bohemian physician, started using the name uterine fibroid (2Martin J.P. The etiology of fibromyomata of the; Mar, a review of the literature and preliminary comments on the Hartman-Littrell technique of assay.J Natl Med Assoc. 1948; 40: 49-58PubMed Google Scholar). Despite this long-dated history of UF, the treatment of this pathology, which was predominantly operative in nature, did not make an appearance until the nineteenth century when American surgeons documented their experience in the treatment of these large masses. During this time, the treatment options for UFs were quite limited. Surgical treatments included hysterectomy, myomectomy, oophorectomy, and the removal of the appendages (3Goelet A.H. Treatment of uterine fibroids.Atlanta Med Surg J. 1894; 11: 10-12Google Scholar). Procedural treatments included Apostoli’s electrical method (4Tivy W.J. Notes on three cases of uterine fibroids under treatment by apostoli's electrical method.Br Med J. 1888; 1: 1376-1377Crossref PubMed Scopus (2) Google Scholar) and the subcutaneous administration of Ergotine injections (3Goelet A.H. Treatment of uterine fibroids.Atlanta Med Surg J. 1894; 11: 10-12Google Scholar). Each option was associated with significant morbidity and mortality, and there was a desperate need to develop less invasive ways to treat UF (3Goelet A.H. Treatment of uterine fibr","journal":"F&S Reports","year":2022,"id":278279,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9537,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":356593,"name":"Michał Ciebiera","orcid":"0000-0001-5780-5983","position":1,"is_corresponding":false},{"id":277444,"name":"Ayman Al‐Hendy","orcid":"0000-0002-8778-4447","position":2,"is_corresponding":false},{"id":950394,"name":"Obianuju Sandra Madueke-Laveaux","orcid":"0000-0002-1994-2183","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-19T00:28:43.133347Z","pmid":"37223760","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}