| Indication | Symptomatic Uterine Leiomyomas |
| Access | Rx / Interventional Radiology / Surgical |
| Diagnostic Criteria | Pelvic Ultrasound / FIGO Classification / Histopathology |
| Safety Profile | Moderate (varies by procedure/medication) |
| Key Marker | Hemoglobin, Ferritin, Pelvic Ultrasound, SSS |
| Est. Cost | Rx: $100–300/mo; Procedures: $5,000–25,000 |
Uterine fibroids (leiomyomas) are highly prevalent, benign tumors of the uterus and female genital tract [1][2]. As a primary clinical challenge in gynecology, they represent the leading indication for hysterectomy worldwide and drive substantial morbidity, including heavy menstrual bleeding, iron deficiency anemia, pelvic pain, and reproductive complications [3][1:1][4][2:1].
Uterine leiomyomas are benign uterine tumors [1:2][2:4].
Leiomyomas are benign, hormone-dependent tumors [7:1], which are often asymptomatic and may remain stable in size and growth over time, though symptoms can return when medical therapies are discontinued [8:1].
Additionally, uterine fibroids may co-exist with other causes of abnormal uterine bleeding, such as adenomyosis and endometrial polyps, within the PALM-COEIN classification system [15][16]. In patients presenting with abnormal uterine bleeding (AUB), co-existing pathologies such as adenomyosis are associated with higher rates of treatment failure and subsequent reintervention following uterine artery embolization (UAE) [17].
Symptomatic leiomyomas present with clinical phenotypes determined by their size, number, and precise FIGO anatomical subtyping [1:3][15:1].
Heavy menstrual bleeding is a hallmark symptom of uterine fibroids, particularly submucosal types (FIGO Types 0, 1, and 2), which can significantly impact a patient's quality of life [1:4][15:2]. The presence of fibroids can expand the uterine cavity and alter normal bleeding patterns, leading to prolonged and heavy flow [1:5][15:3]. These structural presentations often overlap with severe dysmenorrhea (see the Period Pain Action Guide).
Chronic, severe menstrual blood loss from uterine fibroids can deplete iron reserves, leading to iron deficiency anemia [4:4]. According to clinical guidelines, therapeutic reduction in menstrual blood loss is essential to significantly increase hemoglobin levels and resolve fibroid-associated anemia, which in turn leads to substantial improvements in health-related quality of life [4:5][10:1][18][19]. Specific clinical trial cohorts, including analyses of Black women who experience a disproportionately high burden of severe disease, have also demonstrated that long-term medical control of bleeding (e.g., with oral GnRH antagonists) successfully restores hemoglobin concentrations and improves overall quality-of-life scores [9:1][10:2].
Large fibroids can cause bulk symptoms, such as pelvic pressure, pain, abdominal discomfort (often manifesting as pelvic pressure or abdominal bloating), and pelvic or extra-pelvic compressive signs, which can significantly interfere with a patient's quality of life [4:6][20][2:5].
Fibroids that distort the endometrial cavity (impinging on the cavity) can impact the ability to conceive and are evaluated in couples presenting with unexplained infertility [6:1]; these are anatomically classified as FIGO Types 0, 1, and 2 [1:6][5:1]. Although most patients with uterine fibroids have a regular pregnancy, they may experience a higher risk of pregnancy complications and fertility considerations, which must be managed on an individualized basis [21][22].
Accurate diagnostics and anatomical subtyping are mandatory to formulate a rational, evidence-based management plan [1:7][2:6].
The International Federation of Gynecology and Obstetrics (FIGO) classification system maps leiomyomas based on their relationship to the endometrium, myometrium, and serosa [1:8][15:4]:
| FIGO Category | Subtype | Anatomical Description | Primary Clinical Correlate |
|---|---|---|---|
| Submucosal | Type 0 | Pedunculated, entirely intracavitary [23][5:2] | Associated with abnormal uterine bleeding [1:9][15:5]; submucosal fibroids are managed hysteroscopically [4:7][6:2][24]. |
| Submucosal | Type 1 | Submucosal, <50% intramural extension [23:1][5:3] | Associated with abnormal uterine bleeding [1:10][15:6]; submucosal fibroids are managed hysteroscopically [4:8][6:3][24:1]. |
| Submucosal | Type 2 | Submucosal, intramural extension [23:2][5:4] | Associated with abnormal uterine bleeding [1:11][15:7]; submucosal fibroids are managed hysteroscopically [4:9][24:2], requiring preoperative assessment of submucosal fibroids [6:4]. |
| Other | Type 3 | Abuts endometrium, 100% intramural | Submucosal contact; UAE is effective [25]. |
| Other | Type 4 | Entirely intramural, no endometrial/serosal contact | Myometrial location; may contribute to bulk symptoms or bleeding [23:3][4:10]. |
| Other | Type 5 | Subserosal, intramural extension [23:4][5:5] | Subserosal location [23:5]; surgical removal of subserosal fibroids is generally not recommended in the infertile population [6:5]. |
| Other | Type 6 | Subserosal, <50% intramural extension [23:6][5:6] | Subserosal location [23:7]; surgical removal of subserosal fibroids is generally not recommended in the infertile population [6:6]. |
| Other | Type 7 | Pedunculated subserosal | Pedunculated subserosal location [23:8][2:7]. |
| Hybrid | Type 8 | Other locations (cervical, parasitic, broad ligament) | Ectopic/other locations [15:8][23:9]. |
Uterine leiomyosarcomas are extremely rare, occurring in less than 1 in 1,000 cases [8:2]. It is currently unknown whether leiomyosarcomas represent de novo malignant growth or a transformation from benign uterine fibroids [8:3].
To prevent misdiagnosis and inappropriate intervention, clinicians must systematically evaluate patients against this clinical checklist [1:16][15:9][2:9]:
The clinical management of uterine fibroids spans a wide spectrum from conservative medical therapy to definitive surgery [8:6][4:13][2:11].
[ Patient with Symptomatic Fibroids ]
|
+-------------------------+-------------------------+
| |
[ Fertility Desired ] [ Fertility Completed ]
| |
+-------+-------+ +-------+-------+
| | | |
[ Medical ] [ Surgical ] [ Medical ] [ Intervention/Surg ]
| | | |
- GnRH-ant - Hysteroscopic - GnRH-ant - UAE
- LNG-IUD Myomectomy (Types 0-2) - LNG-IUD - Myolysis / MR-HIFU
- TXA - Laparoscopic - TXA - Hysterectomy
- Oral Iron Myomectomy (Types 3-7) - NSAIDs - Myomectomy
Asymptomatic fibroids do not require intervention [2:12]. Expectant management, which may include periodic clinical observation, is highly appropriate, particularly for premenopausal patients whose tumors are expected to regress naturally after menopause [4:14].
Physicians must discuss the potential consequences of myomas and myomectomy on future pregnancy, including fertility outcomes and potential risks in subsequent pregnancies, which must be managed on an individualized basis [4:31][24:6].
Uterine fibroids represent a profound area of healthcare inequity, disproportionately impacting Black women [9:2][10:3][11:1][12:1]:
Clinical guidelines emphasize that treatment selection should be a shared decision-making process between the patient and healthcare provider, taking into account individual symptoms, fibroid characteristics, and personal goals [30:2].
The clinical efficacy of major interventions for symptomatic uterine fibroids is summarized below based on high-impact clinical trials and consensus guidelines:
| Outcome / Goal | Effect* | Consistency | Evidence Quality | Trials | Notes (population, duration, dose) |
|---|---|---|---|---|---|
| HMB Reduction (LNG-IUD) Local endometrial decidualization and progestin-mediated bleeding suppression |
High | Moderate (GRADE) | Multiple RCTs | Premenopausal women with fibroids; 52 mg levonorgestrel-releasing system; reduces AUB and bleeding intensity [28:8][4:32][24:7]. | |
| HMB & Pelvic Pain Control (GnRH Antagonist) Pituitary gonadotropin suppression with vasomotor and bone preservation |
Very High | High (GRADE) | LIBERTY 1 & 2, LIBERTY LTE | Premenopausal women (including Black cohorts); 40 mg relugolix daily, 1 mg estradiol, 0.5 mg NETA add-back; up to 52 weeks; over 70% response rate at 24w, 87.7% at 52w [29:3][31:1][9:5][10:6][18:3][41][42][19:1][43]. | |
| Menstrual Flow Reduction (Tranexamic Acid) Local endometrial fibrinolysis inhibition during active menses |
High | High (GRADE) | Multi-center RCTs | Reproductive-aged women with HMB; oral dosing during menses only; clinically meaningful non-hormonal flow reduction [28:9][8:12]. | |
| Tumor Shrinkage & Bleeding Control (UAE) Selective arterial occlusion to induce tumor ischemic necrosis |
High | High (GRADE) | FUME Trial, FEMME RCT | Premenopausal women wishing to avoid hysterectomy; fluoroscopic UAE; ~52% mean volume reduction at 6 months; 14–20% reintervention rate within 2–5 years [20:4][35:1][36:2][34:2][33:4][25:2]. | |
| Excision of Leiomyomas (Myomectomy) Direct mechanical removal with uterine wall reconstruction (fertility-preserving) |
High | High (GRADE) | FEMME RCT, Consensus Guidelines | Premenopausal women with symptomatic fibroids; hysteroscopic (submucosal <4 cm), laparoscopic, or open; comparable long-term QoL to UAE, lower reintervention rates [4:33][20:5][36:3][33:5][24:8]. |
Phase 3 extension trials (such as the LIBERTY Long-Term Extension study) demonstrate that oral GnRH antagonists (such as relugolix combination therapy) can be safely administered for up to 52 weeks (12 months) [18:4]. Longer-term usage up to 24 months is supported by real-world and retrospective cohort data, though patient retention on long-term medical therapy can be limited [31:2]. The low-dose hormonal add-back therapy (estradiol 1 mg and norethindrone acetate 0.5 mg) successfully prevents the accelerated bone mineral density loss and severe hot flashes associated with isolated GnRH blockade [29:4][18:5].
Yes. While myomectomy successfully removes existing, visible leiomyomas, the patient remains at risk for the development of new fibroids over time [4:34]. Large multi-database cohort studies demonstrate that the rate of surgical reintervention due to symptomatic recurrence is approximately 15% to 20% within 5 years post-procedure [33:6].
The risk is extremely low. The prevalence of an unsuspected uterine leiomyosarcoma (LMS) in patients undergoing surgery for presumed benign fibroids is less than 1 in 1,000 (less than 0.1%) [8:13]. It remains scientifically unknown whether leiomyosarcoma represents de novo growth or a malignant transformation from benign uterine fibroids [8:14].
The high severity and prevalence of fibroids in Black women are driven by a complex interplay of biological factors and systemic healthcare inequities [9:6][10:7][11:4][12:5]. Clinical trials and extension studies show that Black women carry a significantly higher burden of severe fibroid symptoms, such as severe heavy menstrual bleeding and iron deficiency anemia, but achieve comparable therapeutic response and safety from medical therapies like oral GnRH antagonists [9:7][10:8]. Additionally, national healthcare utilization analyses and clinical cohort studies demonstrate significant disparities in access to minimally invasive and uterine-preserving therapies, with systemic underutilization and lower rates of minimally invasive surgical procedures [14:7][11:5][39:2][40:2][12:6].
Lakabi R, Harth S, Meinhold-Heerlein I. Diagnosis and classification of uterine fibroids. International Journal of Gynaecology & Obstetrics. 2025;168. https://pubmed.ncbi.nlm.nih.gov/40970558/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Brun JL, Guinard C, Bernard V. [Uterine fibroids]. La Revue du praticien. 2024;74(8):891-897. https://pubmed.ncbi.nlm.nih.gov/39439335/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Practice Bulletin No. 228. Management of Symptomatic Uterine Leiomyomas. Obstetrics & Gynecology. 2021;137(6):e100-e115. https://pubmed.ncbi.nlm.nih.gov/34011888/ ↩︎
Vilos GA, Allaire C, Laberge PY. The management of uterine leiomyomas. Journal of Obstetrics and Gynaecology Canada. 2015;37(2):157-178. https://pubmed.ncbi.nlm.nih.gov/25767949/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Bajaj S, Gopal N, Clingan MJ. A pictorial review of ultrasonography of the FIGO classification for uterine leiomyomas. Abdominal Radiology. 2022;47(1):371-385. https://pubmed.ncbi.nlm.nih.gov/34581926/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Carranza-Mamane B, Havelock J, Hemmings R. The management of uterine fibroids in women with otherwise unexplained infertility. Journal of Obstetrics and Gynaecology Canada. 2015;37(3):277-285. https://pubmed.ncbi.nlm.nih.gov/26001875/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Gurusamy KS, Vaughan J, Fraser IS. Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. PLoS ONE. 2016;11(2):e0149631. https://pubmed.ncbi.nlm.nih.gov/26919185/ ↩︎ ↩︎
Perez-Lopez FR, Ornat L, Ceausu I. EMAS position statement: management of uterine fibroids. Maturitas. 2014;79(1):106-116. https://pubmed.ncbi.nlm.nih.gov/24975954/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Stewart EA, Schulmann T, Venable S. The Effect of Relugolix Combination Therapy in Black/African American Women with Uterine Fibroids. Journal of Obstetrics and Gynaecology. 2025;45(1):2487106. https://pubmed.ncbi.nlm.nih.gov/40207912/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Stewart EA, Al-Hendy A, Lukes AS. Relugolix combination therapy in Black/African American women with symptomatic uterine fibroids: LIBERTY Long-Term Extension study. American Journal of Obstetrics and Gynecology. 2024;230(2):243.e1-243.e15. https://pubmed.ncbi.nlm.nih.gov/37863160/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Callegari LS, Katon JG, Gray KE, et al. Associations between Race/Ethnicity, Uterine Fibroids, and Minimally Invasive Hysterectomy in the VA Healthcare System. Women's Health Issues. 2019;29(1):68-75. https://pubmed.ncbi.nlm.nih.gov/30293778/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Carey C, Silvestrini M, Callegari LS, et al. "I Wasn't Presented With Options": Perspectives of Black Veterans Receiving Care for Uterine Fibroids in the Veterans Health Administration. Women's Health Issues. 2023;33(6):638-646. https://pubmed.ncbi.nlm.nih.gov/37689493/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Katon JG, et al. Racial disparities in uterine fibroids and endometriosis: a systematic review and application of social, structural, and political context. Fertility and Sterility. 2023;120(3):595-603. https://pubmed.ncbi.nlm.nih.gov/36682686/ ↩︎ ↩︎ ↩︎
Elhakim TS, Smolinski-Zhao S, Miyasato D. Disparities in Utilization of Uterine Fibroid Embolization. JAMA Network Open. 2025;8(9):e2512345. https://pubmed.ncbi.nlm.nih.gov/40956582/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Munro MG, Critchley HOD, Fraser IS. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. International Journal of Gynaecology & Obstetrics. 2018;143(3):393-408. https://pubmed.ncbi.nlm.nih.gov/30198563/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Munro MG, Critchley HO, Broder MS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. International Journal of Gynaecology and Obstetrics. 2011;113(1):3-13. https://pubmed.ncbi.nlm.nih.gov/21345435/ ↩︎
Wu Q, Motaghi M, Tang H. Outcome prediction for symptomatic patients with fibroids who underwent uterine artery embolization. Clinical Imaging. 2024;105:110034. https://pubmed.ncbi.nlm.nih.gov/38039750/ ↩︎
Al-Hendy A, Lukes AS, Poindexter AN 3rd. Long-term Relugolix Combination Therapy for Symptomatic Uterine Leiomyomas. Obstetrics and Gynecology. 2022;140(6):952-960. https://pubmed.ncbi.nlm.nih.gov/36357960/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Stewart EA, Lukes AS, Venturella R. Quality of life with relugolix combination therapy for uterine fibroids: LIBERTY randomized trials. American Journal of Obstetrics and Gynecology. 2023;228(3):320.e1-320.e17. https://pubmed.ncbi.nlm.nih.gov/36370871/ ↩︎ ↩︎
Daniels J, Middleton LJ, Cheed V. Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT. Health Technology Assessment. 2022;26(22):1-134. https://pubmed.ncbi.nlm.nih.gov/35435818/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Vitale SG, Padula F, Gulino FA. Management of uterine fibroids in pregnancy: recent trends. Current Opinion in Obstetrics & Gynecology. 2015;27(6):432-437. https://pubmed.ncbi.nlm.nih.gov/26485457/ ↩︎
Sirkeci F, Moss J, Belli AM. Effects on heavy menstrual bleeding and pregnancy of uterine artery embolization (UAE) or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: The FEMME randomized controlled trial. International Journal of Gynaecology & Obstetrics. 2023;160(2):567-575. https://pubmed.ncbi.nlm.nih.gov/36511801/ ↩︎
Gomez E, Nguyen MT, Fursevich D. MRI-based pictorial review of the FIGO classification system for uterine fibroids. Abdominal Radiology. 2021;46(6):2701-2713. https://pubmed.ncbi.nlm.nih.gov/33385249/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Marret H, Fritel X, Ouldamer L. Therapeutic management of uterine fibroid tumors: updated French guidelines. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2012;165(2):156-164. https://pubmed.ncbi.nlm.nih.gov/22939241/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Ito H, Nakai M, Yunaiyama D. Efficacy of uterine artery embolization (UAE) for uterine fibroids according to FIGO classification: a single-center experience. Japanese Journal of Radiology. 2024;42(2):167-174. https://pubmed.ncbi.nlm.nih.gov/37815695/ ↩︎ ↩︎ ↩︎
Shrivastava A, Jindal G, Kalpdev A. Role of MRI and FIGO Staging in Evaluation of Fibroids - A Pictorial Review. Maedica. 2023;18(1):111-118. https://pubmed.ncbi.nlm.nih.gov/37266473/ ↩︎ ↩︎
Mikes BA, Vadakekut ES, Sparzak PB. Abnormal Uterine Bleeding. StatPearls. 2025. https://pubmed.ncbi.nlm.nih.gov/30422508/ ↩︎
Diaz I, Lumsden MA, Zeppernick M. Medical treatment of fibroids: FIGO best practice guidance. International Journal of Gynaecology & Obstetrics. 2025. https://pubmed.ncbi.nlm.nih.gov/40927887/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Al-Hendy A, Lukes AS, Poindexter AN 3rd. Treatment of Uterine Fibroid Symptoms with Relugolix Combination Therapy. The New England Journal of Medicine. 2021;384(7):630-642. https://pubmed.ncbi.nlm.nih.gov/33596357/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Chen I, Kives S, Randle E. Guideline No. 461: The Management of Uterine Fibroids. Journal of Obstetrics and Gynaecology Canada. 2025;47(8):101234. https://pubmed.ncbi.nlm.nih.gov/40562356/ ↩︎ ↩︎ ↩︎
De Angelis MC, Ambrosetti F, Reppuccia S. Safety and efficacy of relugolix combination therapy in symptomatic uterine fibroids. Facts, Views and Vision in ObGyn. 2025. https://pubmed.ncbi.nlm.nih.gov/41029957/ ↩︎ ↩︎ ↩︎
Amoah A, Joseph N, Reap S. Appraisal of national and international uterine fibroid management guidelines: a systematic review. BJOG: An International Journal of Obstetrics and Gynaecology. 2022;129(3):365-374. https://pubmed.ncbi.nlm.nih.gov/34532956/ ↩︎
Deipolyi AR, Annie F, Bush SH 2nd. Hysterectomy and Myomectomy versus Uterine Artery Embolization for Symptomatic Fibroids and Adenomyosis: National and Regional Trends and Adverse Events in 70,000 Patients. Journal of Vascular and Interventional Radiology. 2025;36(6):890-901. https://pubmed.ncbi.nlm.nih.gov/40024281/ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎
Manyonda IT, Bratby M, Horst JS. Uterine artery embolization versus myomectomy: impact on quality of life--results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial. Cardiovascular and Interventional Radiology. 2012;35(3):530-538. https://pubmed.ncbi.nlm.nih.gov/21773858/ ↩︎ ↩︎ ↩︎
Edwards RD, Moss JG, Lumsden MA. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. The New England Journal of Medicine. 2007;356(4):360-370. https://pubmed.ncbi.nlm.nih.gov/17251532/ ↩︎ ↩︎
Tzanis AA, Antoniou SA, Gkegkes ID. Uterine artery embolization vs myomectomy for the management of women with uterine leiomyomas: a systematic review and meta-analysis. American Journal of Obstetrics & Gynecology. 2024;231(2):189-201. https://pubmed.ncbi.nlm.nih.gov/38280434/ ↩︎ ↩︎ ↩︎ ↩︎
Peng J, Wang J, Shu Q. Systematic review and meta-analysis of current evidence in uterine artery embolization vs myomectomy for symptomatic uterine fibroids. Scientific Reports. 2024;14:19245. https://pubmed.ncbi.nlm.nih.gov/39164326/ ↩︎
ACR Appropriateness Criteria Management of Uterine Fibroids: 2023 Update. Journal of the American College of Radiology. 2024;21(6S):S123-S135. https://pubmed.ncbi.nlm.nih.gov/38823944/ ↩︎ ↩︎
Katon JG, Bossick AS, Doll KM, et al. Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs. Medical Care. 2019;57(12):955-961. https://pubmed.ncbi.nlm.nih.gov/31730567/ ↩︎ ↩︎ ↩︎
Carey CM, Katon JG, Bossick AS, et al. Uterine Weight as a Modifier of Black/White Racial Disparities in Minimally Invasive Hysterectomy Among Veterans with Fibroids in the Veterans Health Administration. Health Equity. 2022;6(1):922-929. https://pubmed.ncbi.nlm.nih.gov/36636115/ ↩︎ ↩︎ ↩︎
Venturella R, Rechberger T, Zatik J. Relugolix combination therapy in European women with symptomatic uterine fibroids: a subgroup analysis from the randomized phase 3 LIBERTY pivotal trials. Gynecological Endocrinology. 2023;39(1):2243452. https://pubmed.ncbi.nlm.nih.gov/37634528/ ↩︎
Stewart EA, Lukes AS, Venturella R. Relugolix Combination Therapy for Uterine Leiomyoma-Associated Pain in the LIBERTY Randomized Trials. Obstetrics and Gynecology. 2022;139(6):1070-1081. https://pubmed.ncbi.nlm.nih.gov/35675604/ ↩︎
Catherino WH, Al-Hendy A, Zaim S. Efficacy and safety of relugolix combination therapy in women with uterine fibroids and adenomyosis: subgroup analysis of LIBERTY 1 and LIBERTY 2. Fertility and Sterility. 2025;124(3):450-461. https://pubmed.ncbi.nlm.nih.gov/40320117/ ↩︎