A 38-year-old woman with symptomatic uterine fibroids (heaviest fibroid 8 cm, intramural, no submucosal component) seeks non-surgical management. She declines surgery. The MOST appropriate pharmacological long-term management is:

• A Combined oral contraceptive pill
• B GnRH agonist (leuprolide depot) indefinitely
• C Relugolix combination (relugolix-estradiol-norethindrone acetate) ✓
• D Ulipristal acetate (selective progesterone receptor modulator)

Explanation

Relugolix combination (relugolix 40 mg + estradiol 1 mg + norethindrone acetate 0.5 mg orally once daily) is an FDA-approved oral GnRH antagonist combination approved for long-term management of heavy menstrual bleeding due to uterine leiomyomas. Unlike GnRH agonists, antagonists act immediately without initial flare and the add-back therapy allows longer-term use. Ulipristal acetate has been withdrawn/restricted in many countries due to serious liver toxicity. GnRH agonists alone cause bone loss limiting long-term use. COCs have modest fibroid effect.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.