To be clear the market is large enough for more than one drug to do well. The largest challenge is not to battle ABBV but to get gyns to prescribe, but it shouldn't be a hard sell IMO despite the prior launch experience w Orlissa (for the reasons I mentioned previously)
when you have a pt w fibroids if they have menometrorrhagia there is almost always a submucous component (or it is entirely in the uterine cavity). so location matters more than anything when there is a correlate w symptoms like bleeding. This is easily amenable to hysteroscopic resection so you can offer a more definitive therapy - and this is important - in a sugi center. I stepped away from surgery the last few years, but operating in the hospital was always a pain - inefficient, you get bumped for emergencies, etc. surgical centers are a pleasure and you can bang out a bunch of hysteroscopies back to back - so it is a great money maker compared to a laparoscopy in the hospital, which is the surgical option for endo
a laparoscopy is also a much bigger deal even though it is also same day - recovery, incisions, higher risks
fibroids also have uterine artery embolization as an option (and endometrial ablation etc)
for endo just laparosocpy, which is jsut a bigger to do, and to your question not as lucrative given the time, need for hospital, etc.
pelvic pain in general is a thorn in the side of gyns - they are always looking to refer out and hate seeing these patients for the most part. menomet, fibroids, is easier to manage, and you can also offer hysterctomy and now zero recurrence if done w childbearing and many fibroids cause other symptoms pressure etc that meds cannot address
endo only gets better after menopause no definitive alternative (high recurrence after surgery)
sorry for the long ramble..
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