Uterine leiomyomas are commonly detected with a prevalence reaching up to 60% of reproductive-aged women [
1,
2] and affect women’s quality of life due to heavy menstrual bleeding or dysmenorrhea [
3‐
5]. Leiomyomas grow according to estradiol exposure and decrease after post-menopause [
6,
7]. In clinical practice, pharmacotherapy or surgical treatment is proposed for serious symptoms like abdominal distension, dysuria, infertility, or severe anemia due to heavy menstrual bleeding caused by leiomyomas. In the case of pharmacotherapy, a gonadotropin-releasing hormone (GnRH) receptor agonist (i.e., leuprorelin acetate or goserelin acetate) has been used to pause the menstrual cycle [
8]. However, it induces a transient increase in gonadotropins and sex hormones, resulting in a clinical flare-up or temporary worsening of symptoms, and typically takes about 4 weeks to achieve a therapeutic effect [
3,
9]. GnRH receptor antagonists (i.e., relugolix, elagolix, or linzagolix) are also used as newer treatments for uterine leiomyomas [
10,
11]. Relugolix is a new orally active small molecule GnRH receptor antagonist [
12‐
14] which proved its sufficient efficacy to suppress estradiol without the transient estradiol flare-up compared with GnRH agonist [
15,
16]. However long-term administration should not be permitted liable to for climacteric disorder or osteoporosis. In the case of surgical treatment, pharmacotherapies like GnRH agonists or antagonists aimed at the reduction of leiomyoma and uterine volume or improvement of anemia are also introduced before the surgical treatment to conduct less invasive surgery (i.e., to reduce blood loss or surgical duration). However, the clinician often encounters cases in which menopausal symptoms are thought to be drug-related at about 8 weeks after the beginning of treatment, making it difficult to continue treatment [
17]. Since the phase III trial was designed for relugolix administration to patients with leiomyoma, the leiomyoma volume as a secondary endpoint was reduced by 43.28 ± 33.85% by 12 weeks and 49.75 ± 34.33% by 24 weeks of administration compared with the baseline; we have hypothesized that everyday administration for 8 weeks and subsequently every-other-day administration of relugolix only for maintaining the effect could be a compatible method [
18].