Several medications can ease the heavy bleeding that fibroids cause, and some of them work well. The strongest evidence is for the newer daily pills that combine a GnRH antagonist with low-dose hormones (relugolix combination, sold as Myfembree, and elagolix combination, sold as Oriahnn). Tranexamic acid, the 52-mg hormonal IUD and birth control pills are other options. The catch is that medication controls symptoms while you take it. It does not remove fibroids, and the strongest option is limited to 24 months because of bone loss.
This guide walks through each option, what the research shows, and how to know when it may be time to look at a procedure such as uterine fibroid embolization (UFE).
What fibroid medications can and cannot do
Most fibroid medicines target heavy menstrual bleeding, which is the symptom that sends many women to the doctor. The American College of Obstetricians and Gynecologists (ACOG) 2021 practice bulletin on fibroids lists several drugs that "can be considered" for heavy bleeding caused by fibroids. These recommendations are graded Level B, meaning they rest on limited or inconsistent evidence rather than the strongest trials.
Medication is less helpful for bulk symptoms such as pelvic pressure, a visibly larger belly or needing to urinate often. Those come from the size and position of the fibroids, and the drugs below were mainly tested on bleeding. If pressure is your main problem, ask your doctor whether a medical option is realistic for you at all.
Fibroid medications at a glance
| Medication | How it is taken | What the evidence shows | Main limits |
|---|---|---|---|
| Relugolix combination (Myfembree) | One pill daily | About 71% to 72% met the bleeding goal vs 15% to 17% on placebo (two trials, 768 women) | 24-month limit for bone loss; blood clot warning |
| Elagolix combination (Oriahnn) | Two doses daily | 68.5% and 76.5% met the bleeding goal vs 8.7% and 10.5% on placebo (two trials, 790 women) | 24-month limit for bone loss; blood clot warning |
| Tranexamic acid (Lysteda) | Tablets during the period only | ACOG: "can be considered" for fibroid bleeding | Treats bleeding only |
| 52-mg levonorgestrel IUD | Placed in the uterus | ACOG: "can be considered" for fibroid bleeding | Fibroids that distort the cavity can affect placement; ask your gynecologist |
| Birth control pills or progestin-only methods | Daily or ongoing | ACOG calls them a reasonable option, with "limited direct data" | Effect on fibroid bleeding is less studied |
| NSAIDs (ibuprofen, naproxen) | During the period | Reduce heavy bleeding vs placebo in women without fibroids | Weaker than TXA or the IUD; not tested in fibroid bleeding |
| Leuprolide (Lupron Depot) | Injection | FDA-labeled with iron to improve anemia before surgery | Short-term use, usually as a bridge |
Relugolix and elagolix combination pills
These are the newest fibroid-specific drugs. Each pairs a GnRH antagonist, which lowers the body's estrogen, with a small dose of estrogen and progestin "add-back" to soften side effects such as hot flashes and bone loss.
- Elagolix combination (Oriahnn) was approved by the FDA on May 29, 2020, for heavy menstrual bleeding from fibroids in premenopausal women. In its two main trials (790 women, 68% of them Black), 68.5% and 76.5% of women met the study's bleeding goal, compared with 8.7% and 10.5% on placebo. The goal was less than 80 mL of blood loss per period and at least a 50% reduction.
- Relugolix combination (Myfembree) was approved on May 26, 2021. It is one pill a day and is also approved for endometriosis pain. In the LIBERTY 1 and 2 trials (768 women), 72.1% and 71.2% met the same kind of bleeding goal, compared with 16.8% and 14.7% on placebo.
Both labels carry the same important limits. Use "should be limited to 24 months due to the risk of continued bone loss, which may not be reversible." Both have a boxed warning about blood clots and vascular events, and both are contraindicated in women over 35 who smoke and in women with uncontrolled high blood pressure. ACOG's matching recommendation says an oral GnRH antagonist with add-back "can be considered" for fibroid bleeding "for up to 2 years."
That time limit is the key planning point. If you are a few years from menopause, two years of good bleeding control may carry you most of the way. If you are 35, you will likely need a longer-term plan.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Fibroid Treatment Guide.
Tranexamic acid
Tranexamic acid (brand name Lysteda, approved in 2009) helps blood clot in the lining of the uterus. You take it only on heavy days of your period, and it contains no hormones. Its FDA label covers cyclic heavy menstrual bleeding in general, and ACOG says it "can be considered" for bleeding caused by fibroids. It does not change fibroid size or pressure symptoms. Because it affects clotting, tell your doctor about any history of blood clots and every other medicine you take.
The hormonal IUD and birth control
A 52-mg levonorgestrel IUD releases a progestin directly into the uterus and thins its lining. ACOG says it "can be considered" for fibroid-related heavy bleeding. Whether it is a good fit depends on your anatomy. A fibroid that bulges into the cavity can make placement harder, which is one reason your gynecologist will want imaging first.
Combined pills and progestin-only methods are graded more weakly. ACOG calls them a "reasonable option to consider" for heavy bleeding with fibroids, "although there are limited direct data." Many women already use them, and they are worth a fair trial before a procedure if bleeding is the main problem.
NSAIDs and short-term options
Over-the-counter anti-inflammatory drugs such as ibuprofen and naproxen can reduce menstrual blood loss and cramps. A 2019 Cochrane review of 19 randomized trials (759 women) found that NSAIDs reduce heavy bleeding compared with placebo, but are less effective than tranexamic acid or the hormonal IUD. That review only included women whose bleeding had no structural cause, so it did not test women with fibroids. Treat NSAIDs as a helper, not a fibroid treatment.
Leuprolide (Lupron Depot) is an older injected GnRH agonist. Its FDA label for fibroids is narrow: used with iron "for preoperative hematologic improvement of women with anemia caused by fibroids for whom three months of hormonal suppression is deemed necessary." In plain terms, it is a short bridge to build up your blood count before surgery, not a long-term plan.
If your periods have left you tired or short of breath, ask for a blood count. Anemia from heavy bleeding is treatable, and our article on fibroids and anemia explains the testing.
When medication is not enough
Medication may not be the right long-term answer if:
- Bleeding stays heavy after a fair trial, or you remain anemic
- Pressure, bloating or urinary symptoms are your main complaint
- You cannot take hormones, or you smoke and are over 35
- You are approaching the 24-month limit on a GnRH antagonist and are not close to menopause
- Side effects outweigh the benefit
At that point, procedures come into the picture. Uterine fibroid embolization treats all the fibroids at once through a small catheter in an artery, without an abdominal incision, and keeps the uterus. ACOG's 2021 bulletin recommends it for patients who want to keep their uterus and who are counseled about the limited data on pregnancy afterward. Surgery is the other main path, and our comparisons of UFE vs myomectomy and UFE vs hysterectomy set out the trade-offs, including the higher rate of repeat treatment after UFE. For the full menu of options, see our fibroid treatment guide.
When to get help quickly
Call your doctor promptly or go to an emergency room if you soak through a pad or tampon every hour for several hours, feel faint or dizzy, have a racing heart or chest pain, or develop sudden severe pelvic pain. On a GnRH antagonist pill, seek urgent care for signs of a blood clot, such as leg swelling and pain, sudden shortness of breath or chest pain, or stroke symptoms such as sudden weakness or trouble speaking.
Fibroids are almost always benign. The goal of any treatment, pill or procedure, is to give you back control of your periods and your days. A good plan often starts with medication and moves on only if it falls short.
Frequently Asked Questions
Is there a pill that shrinks fibroids?
The approved fibroid pills, relugolix and elagolix combinations, were tested and approved for reducing heavy bleeding, not for removing fibroids. Fibroids remain after you stop, so symptoms can return.
Why can I only take Myfembree or Oriahnn for two years?
Both FDA labels limit use to 24 months because of the risk of continued bone loss, which may not be reversible. ACOG likewise says these pills can be considered for up to 2 years.
Can I take tranexamic acid with fibroids?
ACOG says tranexamic acid can be considered for heavy bleeding caused by fibroids. It is taken only during your period. Tell your doctor about any history of blood clots before starting it.
Does ibuprofen help fibroid bleeding?
NSAIDs reduce heavy menstrual bleeding compared with placebo, but a 2019 Cochrane review found them less effective than tranexamic acid or the hormonal IUD, and those trials excluded women with fibroids. They can help with cramps and as an add-on.
When should I consider UFE instead of medication?
Consider a procedure if bleeding or anemia continues despite a fair trial, if pressure symptoms dominate, if you cannot take hormones, or if you are nearing the 24-month limit and are not close to menopause.
Keep Reading
- Uterine Fibroid Embolization (UFE) in New York City
- UFE vs Myomectomy: Results, Recovery and Fertility Compared
- UFE vs Hysterectomy: What 10 Years of Trial Data Show
- Fibroids and Anemia: Why Heavy Periods Drain Your Iron
- Heavy Periods and Fibroids: What Counts as Heavy and What to Do
- Am I a Candidate for UFE? A Practical Checklist
- Fibroid Treatment Guide: every option, compared
Sources
- ACOG Practice Bulletin No. 228, Obstet Gynecol, 2021 — Management of symptomatic uterine leiomyomas
- FDA, Drugs@FDA — Oriahnn (elagolix, estradiol, norethindrone acetate), NDA 213388, approved 2020
- FDA, Drugs@FDA — Myfembree (relugolix, estradiol, norethindrone acetate), NDA 214846, approved 2021
- FDA, Drugs@FDA — Lysteda (tranexamic acid), NDA 022430, approved 2009
- FDA label (openFDA) — Lupron Depot 3.75 mg (leuprolide acetate), NDA 020011
- Bofill Rodriguez et al., Cochrane Database Syst Rev, 2019 — NSAIDs for heavy menstrual bleeding (19 trials, 759 women)
Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.
Living with heavy periods, pelvic pressure or other fibroid symptoms? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether uterine fibroid embolization is right for you. Call (212) 362-3470 or request a UFE consultation online.
