A 42-year-old Indian woman with symptomatic uterine fibroids is being counselled on available management options. Regarding the medical and surgical management of uterine fibroids, all of the following are established and recommended treatment modalities EXCEPT:

Question

Accepted Answer

B. Uterine artery embolization (UAE) is contraindicated in women of reproductive age and should be reserved only for postmenopausal women. ## Medical and Surgical Management of Uterine Fibroids

**Key Point:** Multiple evidence-based management options exist for symptomatic fibroids, ranging from medical therapy to minimally invasive and surgical interventions. The choice depends on symptom severity, fertility desires, and patient preference.

### Established Management Modalities

| Modality | Mechanism & Evidence | Role |
|----------|----------------------|------|
| **GnRH Agonists** | Suppress FSH/LH → hypogonadism → fibroid shrinkage (40–60%) | Preoperative reduction; short-term symptom relief (max 6 months due to side effects) |
| **SPRMs (Ulipristal Acetate)** | Selective progesterone receptor modulation; reduces fibroid volume 30–50% | Medical management; reduces menorrhagia; minimal endometrial hyperplasia |
| **Hysterectomy** | Complete removal of uterus ± ovaries | Gold standard; definitive cure; most common major gynecological surgery globally |
| **Uterine Artery Embolization (UAE)** | Occludes blood supply to fibroids; causes ischemic necrosis | **NOT contraindicated in reproductive-age women**; preserves uterus; alternative to surgery |

### Why Option 4 Is Incorrect

**High-Yield:** Uterine artery embolization (UAE) is **NOT contraindicated in women of reproductive age**. This is a common misconception.

**Clinical Pearl:** UAE is increasingly used in reproductive-age women who wish to preserve their uterus:

1. **Fertility outcomes** — Studies show pregnancy rates of 40–70% post-UAE in women with fibroids as the sole cause of infertility.
2. **Pregnancy complications** — While UAE carries a small risk of placental abnormalities and preterm labor, it is NOT absolutely contraindicated.
3. **Patient selection** — UAE is appropriate for reproductive-age women with symptomatic fibroids who desire uterine preservation and are counselled on fertility risks.
4. **Alternative to hysterectomy** — For women unwilling or unsuitable for surgery, UAE offers a minimally invasive option.

**Warning:** The outdated teaching that UAE is only for postmenopausal women has been superseded by evidence supporting its use across all age groups with appropriate counselling.

**Mnemonic:** **FAME** — Fibroids managed by **F**ibroid embolization, **A**gonists, **M**odulators (SPRMs), and **E**xcision (hysterectomy/myomectomy) — all are valid across reproductive ages.

Answer

A. GnRH agonists (leuprolide, goserelin) reduce fibroid size by 40–60% and are useful for preoperative shrinkage before myomectomy

Answer

C. Selective progesterone receptor modulators (SPRMs) such as ulipristal acetate reduce fibroid volume and menorrhagia with minimal endometrial changes

Answer

D. Hysterectomy is the definitive treatment for symptomatic fibroids and is the most commonly performed major gynecological surgery worldwide

A 42-year-old Indian woman with symptomatic uterine fibroids is being counselled on available management options. Regarding the medical and surgical management of uterine fibroids, all of the following are established and recommended treatment modalities EXCEPT:

Explanation

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