A 35-year-old with symptomatic uterine fibroids (multiple intramural fibroids, total uterine size 14-week equivalent) wishes to avoid surgery and preserve fertility. Which pharmacological agent is approved in India and Europe as long-term medical management for uterine fibroids?

• A Mifepristone (antiprogestogen)
• B Elagolix (GnRH antagonist with add-back therapy)
• C Danazol (synthetic androgen)
• D Ulipristal acetate (selective progesterone receptor modulator) ✓

Explanation

Ulipristal acetate (UPA), a selective progesterone receptor modulator, was approved in Europe (Esmya) for preoperative and intermittent long-term treatment of uterine fibroids in premenopausal women. It acts by directly inhibiting fibroid proliferation and inducing amenorrhoea. However, in 2020, the EMA recommended suspension of its marketing authorisation due to hepatotoxicity (serious liver injury) concerns. Elagolix is approved in the USA for fibroids with add-back therapy but is not widely available in India.

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

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