Fibroids are basically benign overgrowths of muscle and connective tissue in the wall of the uterus; in more technical parlance they are called leiomyomata or myomas. They may occur in the endometrium (inner lining) or the myometrium (outer lining) of the uterus. They may be large or small, and few or many. Fibroids are rather common, occuring in a perhaps as many as 30 to 40% of perimenopausal women; they typically develop when a woman is in her forties, and usually begin to shrink or even disappear at menopause.
Although fibroids do not become generally cancerous and often do not cause any symptoms, for some women fibroids may become quite serious, causing painful menstrual cramps, and heavy and prolonged menstrual periods. In extreme cases fibroids can grow larger than a melon, interfering with pregnancy and birth, pressing against other nearby organs, and generally causing a lot of pain and discomfort. Women with fibroids may have to deliver by Caesarean section.
Treatment depends on the severity of the fibroids. Unless the fibroids cause pain, nothing is done. If they do, however, there are several options. The most permanent, and most invasive, is hysterectomy; this will remove the fibroids as well as the uterus itself. Women who wish to remain fertile can take hormone therapy to reduce estrogen supply; this will shrink the fibroids, but only temporarily; once the therapy is stopped, the fibroids will return to their previous size. Myomectomy, surgery to remove only the fibroids, will in many cases leave all or part of the uterus intact; it can be performed by surgery or laporoscopy, depending on the size and placement of the fibroids. Uterine artery embolization (UAR) is a less invasive procedure whereby a doctor injects tiny particles or plugs into the arteries which supply blood to the fibroids; after few hours of very painful cramping, the fibroids usually begin to shrink and disappear. Because the procedure is still quite new, the extent to which women can maintain their fertility after UAR is not yet known. And, in a very small percentage of cases the particles can travel through the bloodstream to another area of the body, causing blockage of the blood vessels.
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