For a 32-year-old obese woman with large intramural fibroids causing severe menorrhagia, what is the most appropriate management option?

In the case of a 32-year-old obese woman with large intramural fibroids leading to severe menorrhagia, myomectomy is considered the most appropriate management option. Myomectomy is a surgical procedure specifically designed to remove fibroids while preserving the uterus, making it an ideal choice for women who wish to maintain their fertility or have a strong desire to avoid hysterectomy.

Large intramural fibroids can significantly contribute to heavy menstrual bleeding, as they can distort the uterine cavity and disrupt normal uterine function. By opting for myomectomy, the surgeon can directly target and remove these causative fibroids, which often leads to substantial improvement in menstrual flow and reduction of symptoms related to menorrhagia.

Hysteroscopic resection, while useful for submucosal fibroids, is not appropriate here because the fibroids in this scenario are described as intramural, which may not be effectively treated through this minimally invasive technique. Endometrial ablation, on the other hand, is considered when the goal is to reduce menstrual bleeding and is typically suited for cases without large fibroids, particularly those smaller in size. Finally, while observation and monitoring could be an option in cases of mild symptoms or