A 38-year-old woman with symptomatic uterine fibroids (multiple, largest 5 cm, normal uterine cavity) desires future fertility. She is interested in a non-surgical option. Which treatment most consistently reduces fibroid volume while preserving fertility potential?

• A Uterine artery embolisation (UAE)
• B MRI-guided focused ultrasound surgery (MRgFUS)
• C Ulipristal acetate (selective progesterone receptor modulator) ✓
• D Depot medroxyprogesterone acetate (DMPA)

Explanation

Ulipristal acetate (UPA, 5 mg/day) is a selective progesterone receptor modulator that reduces fibroid volume by 25–45% and controls heavy bleeding, with fertility preservation as an advantage (unlike UAE which carries ovarian insufficiency risk, and MRgFUS which has limited long-term pregnancy data). UPA acts by inducing fibroid apoptosis without the bone density effects of GnRH analogues. However, its use has been restricted in Europe due to liver toxicity concerns, so knowledge of mechanism and comparative indications is tested. DMPA does not 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.