Relugolix combination therapy in symptomatic adenomyosis and uterine fibroids: a case series

Objective: To evaluate the clinical efficacy and safety of a once-daily oral fixed-dose combination of relugolix 40 mg, estradiol 1 mg, and norethisterone acetate 0.5 mg in women with symptomatic adenomyosis coexisting with uterine fibroids. Methods: This case series included six women with uterine fibroids and concomitant adenomyosis, diagnosed by transvaginal ultrasound according to MUSA criteria. All patients received continuous treatment for 12 months. Clinical outcomes included changes in dysmenorrhea and pelvic pain assessed by the Visual Analogue Scale (VAS), menstrual blood loss evaluated through the Pictorial Blood Assessment Chart (PBAC), and hemoglobin levels. Ultrasonographic assessment measured uterine volume and adenomyosis-related features before and after treatment. Results: All patients achieved complete resolution of dysmenorrhea and chronic pelvic pain, with VAS scores reduced to zero. Menstrual bleeding ceased in all cases (PBAC = 0), and hemoglobin levels improved after 12 months. Ultrasound examination demonstrated a reduction in uterine volume ranging from 8.6% to 58.3%, along with partial regression of direct adenomyotic features. No adverse events or treatment discontinuations were reported during follow-up. Conclusions: Relugolix/estradiol/norethisterone acetate combination therapy was effective, well-tolerated, and associated with consistent clinical and sonographic improvement in women with adenomyosis and coexisting fibroids. Future larger-scale, controlled studies with extended follow-up are warranted to validate these findings.