Evidence Points to Relugolix-CT As Helpful Ally Before Fibroid Surgery

Setting the Stage: The Challenge of Fibroid Surgery

For women with uterine fibroids—benign but often troublesome growths—laparoscopic myomectomy is the gold standard for those wishing to preserve fertility or their uterus. Medical pre-treatment can shrink fibroids and improve anemia, but some drugs can make surgery more difficult by distorting tissue planes.

Enter Relugolix: A New Preoperative Option

Relugolix combination therapy (Relugolix–CT)—a mix of relugolix, estradiol, and norethisterone acetate—has emerged as a promising medication for symptom control in fibroids. But does it affect the surgery itself?

A new case series, published in the Archives of Gynecology and Obstetrics, reviewed 24 women undergoing laparoscopic myomectomy. Three received Relugolix–CT for 3, 6, or 9 months before surgery; 21 had no pre-treatment.

Key Findings: Smooth Surgery, Safe Recovery

Blood loss was lower in the Relugolix–CT group (217 mL) compared to those with no pre-treatment (355 mL).

Operating time and hospital stay were similar between groups.

No surgical complications occurred in either group.

Crucially, the fibroid capsule and surgical planes remained clear in all Relugolix–CT patients, making it easy for surgeons to remove the fibroids.

What Makes This Study Stand Out?

Unlike older medications (like some GnRH agonists or SPRMs), which sometimes made tissue sticky or hard to separate, Relugolix–CT did not distort tissue planes or cause fibrosis. This means it can be used to optimize patients before surgery—improving symptoms and potentially reducing blood loss—without making the operation harder.

Limitations and Next Steps

This was a small, retrospective study, and the decision to use Relugolix–CT was not randomized, so results should be seen as preliminary. Further large, controlled trials are needed to confirm these promising findings.

Key Takeaways:

Relugolix–CT may lower blood loss during laparoscopic myomectomy.

No negative effects on surgical planes or fibroid capsule integrity were observed.

Operating time and recovery were not compromised by pre-treatment.

No complications were seen in either group.

Relugolix–CT could be a useful, safe option for preoperative optimization before myomectomy.

Citation:

Vandermolen B, Reindorf M, McMurray R, Aref-Adib M, Odejinmi F. Preoperative relugolix combination therapy in laparoscopic myomectomy: a case series evaluating impact on surgical planes and operative outcomes. Archives of Gynecology and Obstetrics. 2025;312:2025–2029. doi:10.1007/s00404-025-08174-5