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Submucosal fibroid with heavy bleeding — USMLE Step 3 MCQ

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ModerateOB/GYNSubmucosal fibroid with heavy bleedingUSMLE Step 3

A 41-year-old woman presents with 3 months of heavy menstrual bleeding. She soaks pads every 2 hours for 2 days each cycle. Pregnancy test is negative, hemoglobin is 10.1 g/dL, and TSH is normal. Pelvic ultrasound shows a 3-cm submucosal fibroid. She wants to preserve fertility. Which of the following is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Hysteroscopic myomectomy

Submucosal fibroids commonly cause heavy bleeding. Hysteroscopic myomectomy is fertility-sparing and appropriate for a symptomatic intracavitary lesion. Endometrial ablation and hysterectomy are not suitable for fertility preservation.

Reference: ACOG Management of Symptomatic Uterine Leiomyomas guidance