A 36-year-old woman has a posterior wall intramural fibroid of 4 cm causing menorrhagia and dysmenorrhoea. She desires future fertility. Which medical treatment reduces fibroid volume through anti-progestogenic and anti-angiogenic mechanisms?
- A GnRH antagonist (elagolix)
- B Combined oral contraceptive pill
- C Ulipristal acetate (selective progesterone receptor modulator) ✓
- D Levonorgestrel IUS
Correct answer: C. Ulipristal acetate (selective progesterone receptor modulator)
Explanation
Ulipristal acetate (UPA), a selective progesterone receptor modulator (SPRM), reduces fibroid volume through anti-progestogenic, anti-proliferative, and anti-angiogenic mechanisms at the fibroid level. GnRH analogues also reduce fibroid volume via hypo-oestrogenic state but cause menopausal symptoms and bone loss. COC and LNG-IUS manage bleeding but do not consistently reduce 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.