What are the current first-line treatment options for symptomatic uterine fibroids in premenopausal women?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

The current first-line treatment options for symptomatic uterine fibroids in premenopausal women include:

  • Use of the levonorgestrel-releasing intrauterine system (LNG-IUS) as the first treatment for women with no identified pathology or fibroids less than 3 cm in diameter, which are not causing cavity distortion .
  • If LNG-IUS is declined or unsuitable, consider pharmacological options such as tranexamic acid, NSAIDs, combined hormonal contraception, or cyclical oral progestogens .
  • For women with fibroids of 3 cm or more in diameter, consider specialist treatments including uterine artery embolization, myomectomy, or surgical options like hysterectomy, especially if symptoms are severe or unresponsive to medication .

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