**Question:** Kalavati, a 29 year old nulliparous women complains of severe menorrhagia and lower abdominal pain since 3 months. On examination there is a 14 wks size uterus with fundal fibroid. The treatment of choice is.

A. Oral contraceptives
B. Hysterectomy
C. Uterine artery embolization
D. Medical management with Gonadotropin-releasing hormone (GnRH) agonists

**Core Concept:** Severe menorrhagia, also known as heavy or excessive menstrual bleeding, in a patient with a fundal fibroid and a 14 weeks size uterus, is usually indicative of an enlarged uterus and fibroid causing increased blood flow to the uterus.

**Why the Correct Answer is Right:**

C. Uterine artery embolization (UAE) is the treatment of choice in this case because it is a minimally invasive procedure that can effectively reduce blood flow to the fibroid, thereby shrinking the fibroid and alleviating the menorrhagia. The procedure involves occluding or blocking the blood supply to the fibroid through catheterization, which can reduce the size of the fibroid and alleviate the patient's symptoms.

**Why Each Wrong Option is Incorrect:**

A. Oral contraceptives (OCs) are primarily used for contraception and do not address the underlying cause of the menorrhagia, which is the fibroid in this case. OCs may help in controlling excessive bleeding by regulating the menstrual cycle, but they do not address the fibroid itself.

B. Hysterectomy (removal of the uterus) is a major surgery and is not the preferred treatment option for menorrhagia caused by a fibroid. While this procedure eliminates the fibroid and menstrual bleeding, it is a major surgery with substantial risks and complications.

D. Medical management with Gonadotropin-releasing hormone (GnRH) agonists (e.g., Gonadotropin-releasing hormone agonists like Leuprolide) are used to suppress the pituitary gland, which in turn suppresses the ovaries and reduces estrogen production. This can help in reducing menstrual bleeding and the size of the fibroid in some cases. However, GnRH agonists are not as specific as UAE for treating fibroids and may also affect other hormonal levels.

**Clinical Pearls:**

1. Uterine fibroids are benign tumors within or surrounding the uterus that can cause heavy menstrual bleeding and may lead to anemia and other complications if left untreated.
2. UAE is a minimally invasive procedure that can effectively reduce fibroid size and alleviate menstrual bleeding, making it a preferred treatment option over hysterectomy and medical management with GnRH agonists.
3. Oral contraceptives may help with regulating the menstrual cycle, but they do not address the fibroid itself.