Emerging treatments
Gonadotropin-releasing hormone (GnRH) analogues
Although GnRH analogues are used during pre-surgery (e.g., hysterectomy, myomectomy) in women with AUB and fibroids, as well as in the management of women with endometriosis, these agents are not licensed to routinely manage AUB.[80] In patients with significant contraindications to hormonal treatment, tranexamic acid, or non-steroidal anti-inflammatory drugs (NSAIDs); or for whom surgery is not possible, the option of ovarian suppression with GnRH analogues can be considered after a thorough discussion of the risks and benefits. GnRH agonists are associated with an initial flare-up of symptoms before ovarian suppression is achieved around 1 to 2 weeks following administration.[81] GnRH antagonists are effective immediately in suppressing ovarian hormonal production, and create a state of reversible menopause. Long-term use of these agents is associated with significant menopausal adverse effects, in particular, osteoporosis.[50] For that reason, treatment is usually restricted to 6 to 12 months.[82]
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