For a 28-year-old woman with multiple uterine fibroids wanting to maintain reproductive capability, what is the most appropriate treatment?

In the case of a 28-year-old woman with multiple uterine fibroids who wishes to maintain her reproductive capability, the most appropriate treatment is myomectomy. This surgical procedure involves the removal of fibroids while preserving the uterus, allowing the patient to retain her ability to conceive in the future.

Myomectomy is generally indicated when fibroids are causing significant symptoms such as heavy menstrual bleeding, pelvic pain, or fertility issues, and the patient desires to keep her reproductive options open. By opting for a myomectomy, the woman can alleviate her symptoms and potentially improve her chances of achieving pregnancy later on, as the uterus remains intact.

In contrast, a hysterectomy involves the complete removal of the uterus, which would eliminate the possibility of future pregnancies and is typically reserved for patients who no longer wish to conceive or have other compelling indications that outweigh the desire for future fertility. GnRH agonists, while they can shrink fibroids and relieve symptoms temporarily, do not provide a long-term solution and do not preserve reproductive capabilities. Oral progesterone may help manage symptoms associated with fibroids but does not address the fibroids themselves and is not a definitive treatment. Therefore, myomectomy stands out as the best option for this patient who wants to