Sucheta, a 29-year-old nulliparous women complains of severe menorrhagia and lower abdominal pain for 3 months. On examination, there was a 14 weeks size uterus with fundal fibroid. The treatment of choice is:
First, I need to recall the management of fibroids, especially in a nulliparous woman. Fibroids are common, and their treatment depends on factors like size, symptoms, and the patient's desire for fertility. Since she's nulliparous, preserving fertility is important. The options likely include medical management, surgical options like myomectomy, or other procedures.
The presentation includes menorrhagia and a large fibroid. Medical treatments like GnRH agonists can shrink fibroids but are temporary. However, if the fibroid is large and causing significant symptoms, surgical intervention might be necessary. Myomectomy is an option to remove the fibroid while preserving the uterus, which is crucial for future fertility. Alternatively, a hysterectomy would be definitive but not suitable for someone who might want to have children.
The correct answer is likely myomectomy. Let me check the options again. The options aren't listed, but the correct answer is probably C. Myomectomy. The other options might be things like hysterectomy, GnRH agonists, or endometrial ablation. Hysterectomy would be incorrect because she's nulliparous and may want to preserve fertility. GnRH agonists are temporary. Endometrial ablation doesn't address the fibroid itself. So, the treatment of choice here is myomectomy to remove the fibroid and preserve the uterus.
**Core Concept**
This question tests the management of symptomatic uterine fibroids in a nulliparous woman. The key principle is balancing symptom relief with fertility preservation, as fibroid treatment depends on size, symptoms, and reproductive goals.
**Why the Correct Answer is Right**
Myomectomy is the treatment of choice for a nulliparous woman with a large symptomatic fibroid. It removes the fibroid while preserving the uterus, maintaining fertility potential. Fundal fibroids causing menorrhagia and bulk symptoms require surgical excision. Medical therapies (e.g., GnRH agonists) provide temporary shrinkage but are not definitive. Hysterectomy is contraindicated here due to the patient’s nulliparity and desire for future pregnancy.
**Why Each Wrong Option is Incorrect**
**Option A:** Hysterectomy is incorrect as it precludes future fertility and is reserved for non-childbearing women with severe symptoms.
**Option B:** GnRH agonists are incorrect because they induce pseudomenopause temporarily, not address the fibroid’s physical presence, and are not long-term solutions.
**Option D:** Endometrial ablation is incorrect as it targets the endometrium, not the fibroid, and is ineffective for menorrhagia caused by submucosal or bulky fibroids.
**Clinical Pearl**
For nulliparous women with fibroids, *myomectomy* is the gold standard to preserve fertility. Avoid definitive surgeries like hysterectomy unless pregnancy is not desired. Remember: “**Myomectomy = Fibroid removal + Uterus preserved**.”
**Correct Answer: C. Myomectomy**