A fibroid (also known as a myoma, or uterine leiomyoma) is a common benign tumor found in the uterus. If it grows large enough, it can cause pressure on the bladder leading to a frequent need to urinate. It can also interfere with the ability of a woman to carry a pregnancy to term. Fibroids can lead to abnormal uterine bleeding and thus be troublesome for women keeping the laws of niddah. This is most common with fibroids that are found under the uterine lining or within it.
Fibroids should be considered as a possible cause in cases of abnormal bleeding (bleeding between periods, long periods, difficulty getting a valid hefsek taharah). They are generally diagnosed by ultrasound. At times a hysteroscopy may be used to study fibroids that are found in the uterine cavity. If they are small enough and in the right location, they can be removed by this procedure as well.
Fibroids generally resolve spontaneously with menopause. However, if the symptoms interfere with a woman's health (such as causing anemia) or lifestyle (such as embarrassing bleeding or prolonged times of being niddah), they can be treated.
There are numerous treatments available today for fibroids. However, before embarking on any treatment that is solely to prevent the halachic complications of bleeding, one should first consult with a halachic authority to assure that one is really niddah as long as one thinks. At times, issues of spotting can be handled by attention to the laws of stains (ketamim) without the need for any intervention. If intervention is needed, there are two approaches - one is medical and the other is surgical.
Medical interventions generally start with medications whose goal is to deal with the abnormal bleeding, not really to treat the fibroid. These include non steroidal inflammatory drugs (e.g. ibuprofen, naproxyn) and hormonal contraceptives. Mifespristone is currently being studied as a drug that can be used to actually shrink the fibroids.
Surgically, myomectomy is the surgical removal of a fibroid with the sparing of the rest of the uterus. This is particularly considered in women who still wish to have children.
Fibroids can be removed by instruments inserted via the cervix, such as a hysteroscope or resectoscope. The procedure will cause uterine bleeding due to trauma; halachic authorities differ as to whether this bleeding will render a woman niddah. The procedure may also involve cervical dilation to a degree that renders the woman niddah independent of bleeding. Therefore, before undergoing these treatments, a woman should ask her physician the exact details of the instruments to be used and the diameter of the portion inserted to the uterus. This information should be discussed with a halachic authority, preferably before the procedure, to determine if it will make her niddah. Based on the halachic ruling, a woman can try to schedule the procedure in a manner that will make her niddah for as short a time as possible.
Another procedure is known as myolysis. In this procedure, a laparoscope is inserrted via the abdomen to destroy the fibroids by cutting off their blood supply. It does not make a woman niddah.
Another technique available for the treatment of fibroids is uterine artery embolization. This involes inserting a thin catheter into an artery in the groin and directing it to the arteries supplying the fibroids. Small plugs are injected through the catheter to block these arteries and lead to the demise of the fibroid. This procedure does not render a woman niddah.
Hysterectomy (removal of the uterus) is the last resort for the treatment of fibroids. Although it is a form of sterilization, it is halachically permitted to alleviate a woman's medical suffering. However, it is important to assure that other methods are at least considered prior to this final intervention.
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