A 35-year-old woman with fibroid uterus desires fertility preservation. Uterine artery embolisation (UAE) was offered but she declined. She has a 6 cm intramural fibroid. Which medical treatment specifically approved for fibroid management that reduces fibroid volume by blocking GnRH receptors and can be used as a bridge to surgery?

• A Leuprolide acetate alone
• B Ulipristal acetate
• C Norethindrone acetate alone
• D Elagolix + add-back therapy ✓

Explanation

Elagolix (a GnRH receptor antagonist — non-peptide oral compound) combined with add-back estradiol/norethindrone acetate (Oriahnn) is FDA-approved for management of heavy menstrual bleeding associated with fibroids. Unlike GnRH agonists, it does not cause an initial flare; add-back therapy reduces hypoestrogenic side effects while maintaining uterine volume reduction. Leuprolide (GnRH agonist) is used preoperatively but causes initial flare; ulipristal acetate had European approval suspended due to hepatotoxicity concerns.

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

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Written and medically reviewed by the StethoPrep medical team.