A 42-year-old with a 10 cm intramural fibroid (FIGO leiomyoma Type 3) and progressively worsening heavy menstrual bleeding has failed levonorgestrel intrauterine system and tranexamic acid. She wishes to avoid hysterectomy and pregnancy is not desired. Which minimally invasive option has the highest evidence for long-term fibroid volume reduction and symptom control?
- A MRI-guided focused ultrasound surgery (MRgFUS)
- B Uterine artery embolisation (UAE) ✓
- C Laparoscopic myomectomy
- D GnRH agonist therapy for 6 months
Explanation
UAE (transcatheter uterine artery embolisation) has the highest long-term evidence for symptom control in symptomatic fibroids for women seeking uterine preservation. It achieves 40–60% fibroid volume reduction and 85–90% improvement in bleeding symptoms. The HOPEFUL and REST trials (UK) and multiple systematic reviews confirm sustained benefits at 5 years. MRgFUS is less effective for large fibroids (> 8 cm) with incomplete necrosis and has less long-term follow-up data. Laparoscopic myomectomy on a 10 cm intramural fibroid carries significant technical challenge and risk. GnRH agonists are temporary (rebound growth occurs after cessation) and are used as bridge therapy, not definitive treatment.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.