A 38-year-old woman is found to have multiple uterine fibroids (largest 6 cm intramural) with a uterine size of 14 weeks. She has menorrhagia, pressure symptoms, and secondary infertility. She wishes to conceive. She declines surgery. She enquires about medical management. Which drug reduces fibroid volume AND controls bleeding while maintaining fertility potential?
- A Ulipristal acetate 5 mg daily ✓
- B Norethisterone 5 mg twice daily
- C GnRH agonist leuprolide depot 3.75 mg monthly
- D Tranexamic acid 500 mg thrice daily during menses
Explanation
Ulipristal acetate (UPA), a selective progesterone receptor modulator, is the only medical therapy proven to both reduce fibroid volume (by ~20–40%) AND control uterine bleeding, while preserving ovarian function and fertility. GnRH agonists shrink fibroids (rebound after stopping) and cause hypoestrogenism impairing fertility and bone density. Norethisterone and tranexamic acid control bleeding but do not reduce fibroid volume. Note: UPA has been subject to liver safety warnings (MHRA 2020) and is currently restricted; for exam purposes, UPA's pharmacological properties remain tested.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.