A 38-year-old woman with a 12 cm intramural fibroid causing menorrhagia and pressure symptoms refuses hysterectomy and wants to preserve her uterus. She is perimenopausal and has no desire for fertility. Which non-surgical uterus-conserving treatment is most appropriate?

• A Levonorgestrel intrauterine system (LNG-IUS)
• B GnRH agonist long-term therapy
• C Ulipristal acetate 5 mg daily long-term
• D Uterine artery embolisation (UAE) ✓

Explanation

Uterine artery embolisation is the most appropriate non-surgical, uterus-preserving treatment for a large symptomatic fibroid in a woman not desiring fertility. UAE reduces fibroid volume by 40–60% and improves menorrhagia. LNG-IUS is poorly suited for large intramural fibroids distorting the cavity. GnRH agonists cause fibroids to regrow after cessation and are not a long-term solution; they also cause menopausal side effects. Ulipristal acetate (Esmya) has been restricted in many countries due to liver toxicity concerns.

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

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Written and medically reviewed by the StethoPrep medical team.