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Can Elagolix be used for heavy menstrual bleeding in women?

Medically reviewed by Carmen Pope, BPharm. Last updated on May 20, 2024.

Official answer


Elagolix (brand name Orlissa) is approved to help reduce endometriosis-associated pain, and research has also shown that it can reduce heavy menstrual bleeding in women with fibroids although this is not without side effects. Women with uterine fibroids were treated with elagolix in addition to hormonal “Add-back” therapy for 6 months. 68.5% in one study and 76.5% in the other reported at least a 50% reduction in menstrual blood loss from the start of the study to the final month and a menstrual blood loss of less than 80mL by the final month of the study. Using elagolix (brand name Orlissa) to reduce heavy menstrual bleeding is an unapproved use for the drug; however, there is a combination elagolix treatment available, called Oriahnn that is approved to treat uterine fibroids.

Add-back therapy consisted of hormonal therapy using estradiol, 1 mg, and norethindrone acetate, 0.5 mg, (like a birth control pill) once-daily. Elagolix is a gonadotropin-releasing hormone (GnRH) antagonist that suppresses the release of gonadotropins and ovarian sex steroids and add-back therapy is meant to moderate decreases in bone mineral density and other low estrogen related side effects such hot flushes and night sweats that occur when elagolix is used alone. The percentage of women reporting hot flushes and night sweats as a side effect was 76% in the elagolix plus add-on therapy compared with 90% taking elagolix alone. Oriahnn contains a combination of a higher dose of elagolix, estradiol, and norethindrone, and is approved to treat uterine fibroids.

For women with fibroids there aren't a lot of medication options and some may consider giving elagolix plus add-back therapy (brand name Oriahnn) a try. Other management options for fibroids include hormonal intrauterine devices (IUDs), hysterectomy, and there is some evidence that vitamin D and green tea extract can suppress fibroid growth.

  • Schlaff WD, Ackerman RT, Al-Hendy A, et al. Elagolix for Heavy Menstrual Bleeding in Women with Uterine Fibroids. N Engl J Med 2020;382:328-40. DOI: 10.1056/NEJMoa1904351
  • Walker, M. Elagolix Cuts Uterine Fibroid Bleeding, but at a Cost
    — Therapy may not be worth the menopause-like side effects, expert says.
    May 6, 2019

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