In cases of heavy menstrual flow associated with large fibroids, what is the most appropriate management?

In cases of heavy menstrual flow associated with large fibroids, a hysterectomy is often the most appropriate management option, especially when the fibroids are significantly impacting quality of life and are large enough to warrant surgical intervention. Hysterectomy, the surgical removal of the uterus, not only addresses the heavy menstrual bleeding by removing the fibroid-bearing uterus but also eliminates the fibroids entirely, preventing the recurrence of symptoms. This option is particularly suitable for women who have completed childbearing or do not wish to preserve fertility.

While other options, such as the oral contraceptive pill and the levonorgestrel-releasing intrauterine device (IUD), can help manage symptoms of heavy menstrual bleeding, they do not address the underlying issue of large fibroids directly. These methods may provide symptomatic relief, but they are typically more appropriate for smaller fibroids or for those who may want to retain their uterus.

Myomectomy, which involves the surgical removal of fibroids while preserving the uterus, is another alternative. However, it may not be ideal for large fibroids or when multiple fibroids are involved, as the symptoms could still persist after surgery and there is a risk of recurrence. In cases where the fibroids are substantial and the decision is