Saxenda (liraglutide 3.0 mg) is a GLP-1 receptor agonist licensed in the UK for weight management in adults with obesity or overweight with comorbidities. Many women with uterine fibroids—non-cancerous growths affecting up to 70% of women by age 50—seek effective weight management options, as obesity may exacerbate fibroid symptoms. Understanding the relationship between Saxenda and uterine fibroids is important for informed treatment decisions. Currently, no evidence suggests Saxenda causes, worsens, or directly affects fibroids. This article examines the available evidence, safety considerations, and weight management strategies for women with fibroids considering Saxenda.

Understanding Saxenda and Its Primary Uses

Saxenda (liraglutide 3.0 mg) is a prescription medicine licensed in the UK for weight management in adults with obesity or those who are overweight with weight-related health conditions. It belongs to a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists, which were originally developed for type 2 diabetes management but have proven effective for weight loss at higher doses.

The mechanism of action involves mimicking the naturally occurring hormone GLP-1, which is released from the intestine after eating. Saxenda works by:

• Reducing appetite through effects on brain centres that regulate hunger

• Slowing gastric emptying, which helps you feel fuller for longer

• Improving glucose metabolism through direct incretin actions, including stimulating insulin secretion and suppressing glucagon

Saxenda is administered as a once-daily subcutaneous injection, typically starting at a low dose (0.6 mg) and gradually increasing over five weeks to the maintenance dose of 3.0 mg. According to NICE guidance, it should be used alongside a reduced-calorie diet and increased physical activity as part of a comprehensive weight management programme.

The medication is indicated for adults with a body mass index (BMI) of 30 kg/m² or greater, or 27 kg/m² or greater in the presence of at least one weight-related comorbidity such as pre-diabetes, type 2 diabetes, hypertension, dyslipidaemia, or obstructive sleep apnoea.

Importantly, NHS funding for Saxenda is restricted by NICE Technology Appraisal 664, which specifies that treatment should only be initiated within specialist tier 3 weight management services. Treatment should be discontinued if patients have not lost at least 5% of their initial body weight after 12 weeks on the maximum tolerated dose, as continued use is unlikely to provide meaningful benefit.

What Are Uterine Fibroids and Their Impact on Health

Uterine fibroids (also called leiomyomas or myomas) are non-cancerous growths that develop in or around the uterus. They are composed of muscle and fibrous tissue and can vary considerably in size, from as small as a pea to as large as a melon. According to NHS information, fibroids are extremely common, affecting up to 70% of women by the age of 50, though many women remain asymptomatic and unaware of their presence.

The exact cause of fibroids remains unclear, but several factors influence their development and growth:

• Oestrogen and progesterone appear to promote fibroid growth, as fibroids contain more receptors for these hormones than normal uterine tissue

• Genetic factors play a role, with fibroids running in families

• Ethnicity, with Black women experiencing higher rates and earlier onset

• Obesity and increased body weight, which may influence hormone levels

When symptomatic, fibroids can significantly impact quality of life. Common symptoms include heavy menstrual bleeding (menorrhagia), which may lead to iron-deficiency anaemia, pelvic pain or pressure, frequent urination if fibroids press on the bladder, constipation, and in some cases, fertility problems or complications during pregnancy. The severity of symptoms generally correlates with the size, number, and location of fibroids rather than their presence alone.

Diagnosis typically involves pelvic examination and imaging, most commonly transvaginal ultrasound. According to NICE guideline NG88, management depends on symptom severity, fibroid characteristics, and the woman's desire for future fertility, ranging from watchful waiting for asymptomatic cases to medical treatments (such as hormonal therapies) or surgical interventions including myomectomy or hysterectomy for severe cases. Many fibroids naturally shrink after menopause.

When to seek urgent medical attention: Contact your GP promptly if you experience very heavy bleeding (requiring frequent pad/tampon changes, passing large clots), severe anaemia symptoms (extreme fatigue, dizziness, shortness of breath), postmenopausal bleeding, or rapidly enlarging pelvic mass. Seek immediate care if you have severe pain or heavy bleeding with faintness/dizziness.

Current Evidence on Saxenda and Uterine Fibroids

There is currently no evidence of a causal link or safety signal between Saxenda use and the development, growth, or symptoms of uterine fibroids. The medication's Summary of Product Characteristics (SmPC) approved by the MHRA does not list uterine fibroids as a contraindication, adverse effect, or area of specific concern. Clinical trials of liraglutide for weight management, as documented in the European Medicines Agency's assessment report, have not identified fibroids as a treatment-related complication.

The theoretical considerations regarding Saxenda and fibroids relate primarily to weight loss effects rather than direct pharmacological interactions. Since obesity is associated with higher oestrogen levels (due to peripheral conversion of androgens to oestrogen in adipose tissue), significant weight loss might theoretically influence hormone-dependent conditions. However, the relationship between weight loss and fibroid behaviour is complex and not fully understood. Some research suggests that obesity may be associated with increased fibroid risk, but whether weight reduction affects existing fibroids remains unclear.

It is important to note that GLP-1 receptor agonists do not have direct hormonal effects on oestrogen or progesterone pathways. Unlike some weight loss interventions that might affect reproductive hormones, Saxenda's mechanism focuses on appetite regulation and glucose metabolism. Women with fibroids considering Saxenda should understand that while there is no evidence suggesting the medication worsens fibroid symptoms or promotes fibroid growth, the available evidence has limitations.

Currently, no specific monitoring for fibroids is recommended for women taking Saxenda. However, you should consult your GP promptly if you experience new or worsening pelvic symptoms, changes in bleeding patterns, increased pelvic pain or pressure, or other concerning symptoms whilst taking Saxenda. These should be evaluated on their own merits rather than automatically attributed to the medication.

Weight Management Considerations for Women with Fibroids

Women with uterine fibroids often face unique challenges with weight management, and addressing excess weight can be an important component of overall health optimisation. According to NICE guideline NG88, obesity may exacerbate fibroid-related symptoms, particularly heavy menstrual bleeding, and can complicate surgical management if intervention becomes necessary. Furthermore, excess weight is associated with numerous other health conditions that commonly coexist with fibroids.

For women with fibroids considering Saxenda, several factors warrant consideration:

• Symptom monitoring: Women should establish baseline symptoms before starting treatment to distinguish between pre-existing fibroid symptoms and any new concerns

• Anaemia management: If fibroids cause heavy bleeding leading to iron-deficiency anaemia, this should be addressed before or alongside weight management efforts. Your GP should check your full blood count and ferritin levels if you have heavy bleeding, as the reduced-calorie diet accompanying Saxenda use might otherwise compromise nutritional status

• Realistic expectations: Weight loss, whether achieved through Saxenda or other means, is unlikely to resolve fibroid symptoms directly, though general health improvements may occur

The benefits of achieving a healthier weight for women with fibroids extend beyond fibroid management. Weight reduction can improve insulin sensitivity, reduce cardiovascular risk, decrease joint stress, and enhance overall quality of life. For women with fibroids who also have conditions like type 2 diabetes or hypertension—both indications that support Saxenda use—the medication may offer multiple health benefits.

It is worth noting that some women with symptomatic fibroids may find that heavy menstrual bleeding and associated fatigue make it challenging to engage in physical activity, which is an important component of any weight management programme. In such cases, addressing fibroid symptoms through appropriate medical or surgical treatment may actually facilitate more effective weight management efforts. A coordinated approach involving both gynaecological care and NHS tier 3 weight management services often yields the best outcomes.

Safety Considerations and Contraindications for Saxenda Use

Whilst uterine fibroids themselves do not contraindicate Saxenda use, women considering this medication should be aware of its established safety profile. According to the UK SmPC, Saxenda should not be used during pregnancy or breastfeeding. Women of childbearing potential should use effective contraception during treatment and discontinue Saxenda if pregnancy occurs.

The UK SmPC includes important precautions regarding thyroid disease. Patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2) should discuss these conditions with their doctor before starting treatment, as GLP-1 receptor agonists have been associated with thyroid C-cell tumours in animal studies, though human relevance remains uncertain.

Common adverse effects that women should anticipate include:

• Gastrointestinal symptoms (nausea, vomiting, diarrhoea, constipation) affecting up to 40% of users, typically most pronounced during dose escalation

• Injection site reactions such as redness or itching

• Headache and dizziness

• Fatigue, which might be particularly relevant for women already experiencing tiredness from fibroid-related anaemia

Serious but rare risks include pancreatitis (inflammation of the pancreas), gallbladder disease, and hypoglycaemia, particularly in those taking other glucose-lowering medications. Women should seek immediate medical attention if they experience severe, persistent abdominal pain, as this may indicate pancreatitis.

For women with fibroids, specific considerations include monitoring for changes in menstrual bleeding patterns. Whilst Saxenda does not directly affect menstruation, significant weight loss from any cause can sometimes influence menstrual cycles. Any increase in menstrual bleeding, new pelvic pain, or pressure symptoms should prompt gynaecological evaluation rather than being dismissed as medication side effects.

Saxenda should not be used concurrently with other GLP-1 receptor agonists. If you experience any suspected adverse reactions while taking Saxenda, report them through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).

Alternative Weight Management Options for Women with Uterine Fibroids

Women with uterine fibroids who are unable to use Saxenda, prefer alternative approaches, or wish to explore other options have several evidence-based weight management strategies available. A comprehensive, individualised approach typically yields the best long-term results.

Lifestyle interventions remain the foundation of weight management:

• Dietary modification: A balanced, reduced-calorie diet rich in fruits, vegetables, whole grains, and lean proteins, potentially with support from a registered dietitian

• Physical activity: Following the UK Chief Medical Officers' guidelines of at least 150 minutes of moderate-intensity activity weekly, adapted to individual capabilities and any limitations from fibroid symptoms

• Behavioural strategies: Including self-monitoring, goal-setting, and addressing emotional eating patterns, often facilitated through structured programmes or psychological support

Alternative pharmacological options approved for weight management in the UK include:

• Orlistat: A lipase inhibitor that reduces fat absorption, available both on prescription and over-the-counter at lower doses, though gastrointestinal side effects can be troublesome

• Naltrexone/bupropion (Mysimba): A combination therapy that affects appetite control centres in the brain, though it should be used with caution in certain conditions including hypertension

• Semaglutide (Wegovy): A once-weekly GLP-1 receptor agonist with similar mechanism to Saxenda. NHS funding is restricted by NICE Technology Appraisal 875, which specifies use within specialist weight management services for eligible patients

For women with fibroids experiencing symptoms that impair their ability to engage in weight management activities, treating the fibroids themselves may be an important first step. Options include hormonal treatments (such as the levonorgestrel intrauterine system for heavy bleeding), uterine artery embolisation, or surgical interventions. Addressing anaemia through iron supplementation or treating heavy bleeding can significantly improve energy levels and exercise tolerance.

Specialist weight management services, available through NHS referral for those meeting eligibility criteria, can provide multidisciplinary support including medical, dietary, psychological, and exercise components. For individuals with severe obesity (BMI ≥40 kg/m² or ≥35 kg/m² with comorbidities) who have not achieved adequate weight loss through other means, bariatric surgery may be considered according to NICE guidance CG189. Women with fibroids considering bariatric surgery should discuss their gynaecological history as part of pre-operative assessment, though fibroids rarely preclude surgical weight loss interventions.

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