{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T15:07:07Z","timestamp":1790262427503,"version":"4.1.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"7-8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,22]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Not too long ago, Lupron Depot\u00ae (leuprolide acetate), an injectable gonadotropin-releasing hormone (GnRH) agonist, was the only Food and Drug Administration (FDA) approved GnRH analog used to clinically treat abnormal uterine bleeding associated with uterine leiomyoma (AUB-L) when second-line medical management was warranted; however, the FDA has now approved elagolix and relugolix, GnRH antagonists, to be treatment options as well. This is a review of GnRH antagonists for the management of uterine fibroids reviewing their treatment efficacy, side effect profile, and current use in military medicine.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This is a review of studies from multiple electronic databases (Pubmed, ACOG, FDA, U.S. Military Guidelines) published between 1990 and 2021. Keywords used for the search include GnRH antagonist, elagolix, relugolix, uterine leiomyoma, and abnormal uterine bleeding. Our inclusion criteria for articles reviewed were: systematic reviews with the listed keywords, multicenter randomized trials, and meta-analyses. The DODI on Medical Standards for Medical Service, Air Force Aerospace Medicine Waiver Guide, Navy Guidance Aeromedical Reference and Waiver Guide, and the Army Regulation 40-501 Standards of Medical Fitness were used to review the military standards and current restrictions placed on service members.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Thirty-three articles were reviewed and summarized.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Uterine leiomyoma can impact service members\u2019 eligibility and fitness for duty. The oral administration of elagolix and relugolix adds convenience to this drug class through its oral administration while lengthening the duration of treatment up to 24\u2009months. All military medical facilities should advocate for the well-being of their service members by stocking all options available. Health care providers should collaborate with patients in making the best therapy choice that is suited for their lifestyle and military occupation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usac078","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T13:53:16Z","timestamp":1648561996000},"page":"e1620-e1624","source":"Crossref","is-referenced-by-count":9,"title":["A Review of GnRH Antagonists as Treatment for Abnormal Uterine Bleeding-Leiomyoma (AUB-L) and Their Influence on the Readiness of Service Members"],"prefix":"10.1093","volume":"188","author":[{"given":"Danielle","family":"Wright","sequence":"first","affiliation":[{"name":"Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Won","family":"Kim","sequence":"additional","affiliation":[{"name":"Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halle","family":"Lindsay","sequence":"additional","affiliation":[{"name":"Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William H","family":"Catherino","sequence":"additional","affiliation":[{"name":"Gynecologic Surgery and Obstetrics, Uniformed Services University of Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"2023072301093414200_R1","doi-asserted-by":"crossref","first-page":"e100","DOI":"10.1097\/AOG.0000000000004401","article-title":"Committee on Practice Bulletins\u2013Gynecology: Management of symptomatic uterine leiomyomas: ACOG practice bulletin, number 228","volume":"137","author":"American College of Obstetricians and Gynecologists\u2019","year":"2021","journal-title":"Obstet Gynecol"},{"key":"2023072301093414200_R2","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD000547.pub2","article-title":"Preoperative medical therapy before surgery for uterine fibroids","author":"Lethaby","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2023072301093414200_R3","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/GRF.0000000000000171","article-title":"An evidence-based approach to the medical management of fibroids: a systematic review","volume":"59","author":"Bartels","year":"2016","journal-title":"Clin Obstet Gynecol"},{"key":"2023072301093414200_R4","volume-title":"Leuprolide Depot 3-Month 11.25 mg (Leuprolide Acetate) [Prescribing Information]","year":"2020"},{"key":"2023072301093414200_R5","first-page":"10","article-title":"Uterine fibroids, active component females, U.S. Armed Forces, 2001-2010","volume":"18","author":"Armed Forces Health 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Urol"},{"key":"2023072301093414200_R12","article-title":"Oriahnn\u00ae","author":"FDA","year":"2020"},{"key":"2023072301093414200_R13","article-title":"Myfembree\u00ae","author":"FDA","year":"2021"},{"key":"2023072301093414200_R14","article-title":"Firmagron\u00ae","author":"FDA","year":"2008"},{"key":"2023072301093414200_R15","article-title":"Cetrotide\u00ae","author":"FDA","year":"2008"},{"key":"2023072301093414200_R16","article-title":"AntagonTM","author":"FDA","year":"2007"},{"key":"2023072301093414200_R17","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/s40262-019-00840-7","article-title":"Clinical pharmacology of elagolix: an oral gonadotropin-releasing hormone receptor antagonist for endometriosis","volume":"59","author":"Shebley","year":"2020","journal-title":"Clin Pharmacokinet"},{"key":"2023072301093414200_R18","doi-asserted-by":"crossref","first-page":"4579","DOI":"10.1210\/jc.2015-2770","article-title":"Medical castration using the investigational oral gnrh 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