Emerging treatments
Gonadotrophin-releasing hormone (GnRH) analogs
Although GnRH analogs are used during presurgery (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.[82] In patients with significant contraindications to hormonal treatment, tranexamic acid, or nonsteroidal anti-inflammatory drugs (NSAIDs); or for whom surgery is not possible, the option of ovarian suppression with GnRH analogs 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.[83] 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.[53] For that reason, treatment is usually restricted to 6 to 12 months.[84]
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