A 38-year-old woman with a 7 cm intramural fibroid and menorrhagia leading to Hb 8.5 g/dL desires uterine conservation. She declines surgery. The BEST non-surgical option to rapidly reduce fibroid volume AND treat anaemia is:

• A Ulipristal acetate 5 mg daily for 3 months
• B Levonorgestrel IUS insertion
• C Tranexamic acid 1 g three times daily during menses
• D GnRH agonist (leuprolide 3.75 mg IM monthly) for 3 months ✓

Explanation

GnRH agonists (e.g., leuprolide) reduce fibroid volume by 35–65% over 3–6 months by creating a hypoestrogenic state, and also induce amenorrhoea, allowing haemoglobin correction before surgery. They are frequently used as pre-operative optimisation agents. Ulipristal acetate (SPRM) was also effective but has been withdrawn/restricted in many countries including India due to serious hepatotoxicity concerns. LNG-IUS and tranexamic acid reduce bleeding but do not reduce fibroid size.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.