Partially Expelled Necrotic Uterine Fibroid After Relugolix Combination Therapy: Case Report and Literature Overview on Adverse Effects of GnRH Antagonists

Background and Clinical Significance: Relugolix combination therapy (Relugolix CT) has emerged as an effective oral medical treatment for symptomatic uterine fibroids, offering an alternative to surgical interventions. While generally well tolerated, reports of adverse events beyond the common side effects are limited. Case Presentation: A 34-year-old nulliparous woman presented with abdominal pain and abnormal uterine bleeding. She had previously been diagnosed with a large FIGO Type 1-5 anterior wall fibroid and started on Relugolix CT as a bridge to surgery. At referral, speculum examination revealed a necrotic, malodorous, partially expelled mass protruding through the cervix. Surgical removal under spinal anaesthesia was performed, followed by resection of the intracavitary component. Histopathology confirmed leiomyoma with extensive necrosis. Postoperative imaging showed a residual fibroid, leading to discontinuation of Relugolix and initiation of leuprorelin acetate. The patient reported symptom resolution but was lost to follow-up after 3 months. This case highlights potential serious but under-recognized adverse effects associated with Relugolix CT, particularly in patients with large or intracavitary fibroids. Clinicians should maintain vigilance and ensure appropriate monitoring during treatment. Conclusion: Relugolix CT represents a promising option in uterine fibroid management, but individualized patient evaluation and awareness of possible complications are essential to optimize safety and outcomes. The potential of this therapeutic approach warrants further investigation through randomized clinical trials, while real-world patient data are equally crucial to strengthen the evidence base and support broader clinical applicability.