Symbolic illustration of a woman overcoming heavy menstrual bleeding with elagolix, showcasing renewed uterine health.

Battling Heavy Periods and Fibroids: Is Elagolix the Answer?

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"Explore how Elagolix, with and without add-back therapy, offers new hope for women struggling with heavy menstrual bleeding and uterine leiomyomas, enhancing their quality of life."

Heavy menstrual bleeding, often linked to uterine leiomyomas (fibroids), can significantly disrupt a woman's life. These benign tumors, fueled by estrogen and progesterone, affect a large number of women, leading to prolonged, heavy periods, anemia, pelvic pain, and reduced quality of life. Traditional treatments range from surgery to hormonal birth control, but many have limitations, especially for long-term use.

Elagolix, an oral medication, has emerged as a promising alternative. It works by blocking the gonadotropin-releasing hormone (GnRH) receptor, which in turn lowers estrogen and progesterone levels. This reduction can help manage heavy bleeding, but it also raises concerns about potential bone mineral density loss due to lower estrogen.

A recent study investigated the effectiveness and safety of elagolix, both alone and with 'add-back' hormone therapy (estradiol and norethindrone acetate), in women experiencing heavy menstrual bleeding related to uterine leiomyomas. The study aimed to determine if elagolix could reduce bleeding and whether add-back therapy could minimize side effects like bone density loss.

Elagolix: A New Hope for Managing Heavy Bleeding?

Symbolic illustration of a woman overcoming heavy menstrual bleeding with elagolix, showcasing renewed uterine health.

The study, a double-blind, randomized, placebo-controlled trial, involved premenopausal women with heavy menstrual bleeding (more than 80 mL per month) and uterine leiomyomas. Participants were divided into groups receiving either elagolix alone, elagolix with add-back therapy (different doses of estradiol and norethindrone acetate), or a placebo. The primary goal was to assess the percentage of women achieving a significant reduction in menstrual blood loss (less than 80 mL) by the end of the treatment period.

The results showed that elagolix, both with and without add-back therapy, significantly reduced menstrual blood loss compared to the placebo. Specifically, a large percentage of women in the elagolix groups experienced a substantial reduction in bleeding. The add-back therapy also played a crucial role in mitigating the impact of elagolix on bone mineral density.

Significant Reduction in Bleeding: Elagolix, with and without add-back therapy, markedly decreased menstrual blood loss.
Bone Density Protection: Add-back therapy helped counteract bone mineral density loss associated with elagolix alone.
Improved Quality of Life: Participants in the elagolix groups reported significant improvements in their overall quality of life and reduced symptom severity.
Comparable Efficacy: The 300-mg twice-daily and 600-mg daily elagolix doses showed similar efficacy in reducing bleeding and uterine volume.

While the study highlighted the benefits of elagolix, it also noted some side effects. Hot flushes were a common adverse event in women taking elagolix without add-back therapy. Additionally, there were changes in lipid levels, although these generally returned to baseline after treatment. The study also reported no cases of endometrial hyperplasia or malignancy.

Making Informed Choices

Elagolix presents a significant advancement in managing heavy menstrual bleeding associated with uterine leiomyomas. The option of add-back therapy further enhances its appeal by mitigating potential bone density loss and reducing hot flushes. Women experiencing these challenging conditions now have a more comprehensive range of treatment options to discuss with their healthcare providers, potentially leading to improved health outcomes and a better quality of life. Further studies are warranted to assess long-term outcomes and optimal use strategies, but the initial results are encouraging.

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Everything You Need To Know

What is Elagolix and how does it help with heavy menstrual bleeding?

Elagolix is an oral medication used to manage heavy menstrual bleeding, often associated with uterine leiomyomas. It functions by blocking the gonadotropin-releasing hormone (GnRH) receptor. This action lowers estrogen and progesterone levels in the body, which in turn reduces heavy bleeding. By reducing these hormone levels, Elagolix helps to manage the excessive bleeding caused by uterine leiomyomas. However, it's important to note that lowering estrogen levels can lead to potential side effects, such as bone mineral density loss, which can be addressed with add-back therapy.

What is 'add-back' therapy and why is it used with Elagolix?

'Add-back' therapy involves the use of estradiol and norethindrone acetate in combination with Elagolix. It is used to mitigate the side effects associated with reduced estrogen levels caused by Elagolix, such as bone mineral density loss and hot flushes. While Elagolix effectively lowers estrogen and progesterone to manage heavy bleeding, this reduction can lead to undesirable effects. Add-back therapy helps to restore some of the hormonal balance, providing a more tolerable treatment option that preserves the benefits of Elagolix while minimizing its adverse impacts.

How effective is Elagolix in reducing menstrual blood loss, and what were the key findings of the study?

Elagolix is highly effective in reducing menstrual blood loss in women with heavy menstrual bleeding due to uterine leiomyomas. A randomized controlled trial showed that Elagolix, both with and without add-back therapy, significantly reduced menstrual blood loss compared to a placebo. The study's key findings included a substantial reduction in bleeding among women in the Elagolix groups, the mitigation of bone mineral density loss with add-back therapy, and improvements in the participants' overall quality of life. Additionally, the study indicated that different doses of Elagolix (300-mg twice-daily and 600-mg daily) showed similar efficacy in reducing bleeding and uterine volume.

What are uterine leiomyomas, and how do they contribute to heavy menstrual bleeding?

Uterine leiomyomas, commonly known as fibroids, are benign tumors in the uterus. These tumors are fueled by estrogen and progesterone, and they affect a large number of women. Uterine leiomyomas contribute to heavy menstrual bleeding by increasing the surface area of the uterine lining, which leads to prolonged and heavier periods. They can also cause other symptoms like anemia, pelvic pain, and a reduced quality of life. Elagolix addresses this issue by reducing estrogen and progesterone levels, thereby shrinking the fibroids and reducing the associated bleeding.

What are the side effects associated with Elagolix, and how does 'add-back' therapy help manage them?

Common side effects associated with Elagolix include hot flushes and changes in lipid levels. The hot flushes are primarily experienced by women taking Elagolix without add-back therapy due to the reduced estrogen levels. Add-back therapy, which involves the administration of estradiol and norethindrone acetate, helps manage these side effects by partially restoring hormonal balance. This therapy counteracts bone mineral density loss and reduces the occurrence of hot flushes, making the treatment more tolerable. The lipid level changes generally return to baseline after the treatment is completed. The study reported no cases of endometrial hyperplasia or malignancy.