Submucosal uterine fibroids cause heavy menstrual bleeding primarily by which mechanism?

• A Increased endometrial surface area and compression of surrounding endometrium leading to impaired contractility ✓
• B Obstruction of uterine venous outflow causing venous congestion
• C Increased endometrial aromatase activity causing local estrogen excess
• D Interference with endometrial prostaglandin synthesis causing vasodilation

Explanation

Submucosal fibroids cause menorrhagia primarily by increasing endometrial surface area and compressing the overlying endometrium, which impairs myometrial contractility and vascular constriction needed for hemostasis. They also distort the endometrial cavity and may cause ulceration over the fibroid surface. Options B, C, and D are not the primary mechanisms.

Reference: Te Linde's Operative Gynecology, 12th ed.

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