Uterine fibroids are common benign gynecological tumors. Submucosal fibroids, which protrude into the uterine cavity, may sometimes extend through the cervical canal as pedunculated masses, causing abnormal uterine bleeding (AUB). However, co-occurrence of fibroid expulsion with pelvic organ prolapse (POP) is rare. We report the case of a 52-year-old multiparous woman who was referred to our hospital for the treatment of fibroid expulsion and complete uterine prolapse. Hysterectomy and colporrhaphy were deemed necessary to alleviate these symptoms. Preoperative anemia was managed using oral Relugolix, a gonadotropin-releasing hormone (GnRH) antagonist, to reduce uterine bleeding. On the 33rd day of treatment, the patient presented with severe uncontrollable vaginal bleeding, necessitating emergency surgery. Abdominal and vaginal surgical approaches have been used for total hysterectomy, colporrhaphy and perineoplasty. This case highlights the necessity of surgical innovation in treating coexisting fibroid expulsion and POP and the potential risk of AUB during GnRH antagonist therapy.