In a patient with symptomatic uterine fibroids (menorrhagia, 14-week size uterus) who strongly desires fertility preservation, which medical therapy specifically acts on GnRH receptors to reduce fibroid volume prior to surgery?

• A Ulipristal acetate — selective progesterone receptor modulator reducing fibroid proliferation
• B Danazol — weak androgen suppressing pituitary gonadotropins and fibroid estrogen receptor expression
• C Tranexamic acid — antifibrinolytic reducing menorrhagia without affecting fibroid volume
• D Relugolix — oral GnRH receptor antagonist causing competitive blockade and reversible hypogonadism ✓

Explanation

Relugolix (and its combination formulation with estradiol/norethindrone acetate — relugolix combination therapy) is an oral GnRH receptor antagonist approved for uterine fibroids. Unlike GnRH agonists (which cause an initial flare), GnRH antagonists cause immediate competitive receptor blockade without a flare, producing rapid hypoestrogenism and fibroid volume reduction. The combination with add-back hormone therapy limits bone loss and menopausal symptoms. Ulipristal acetate (Esmya) was effective but suspended in Europe due to rare hepatotoxicity. Danazol has significant side effects. Tranexamic acid addresses bleeding but not fibroid volume.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.