One gets the impression that because fibroid disease is essentially benign, it has at-
tracted minimal research, and commands a tiny fraction of the research money
cake. How else could one explain the fact that we know so little about the aetiology
of such a common disease? How else could one explain the fact that until as recently
as 10–15 years agothe only treatment options open to afflictedwomenwerea hyster-
ectomyorconventionalopenmyomectomy (apartofcoursefromgrinningandbearing
it!). Yes, fibroids are indeed benign in the biological sense, but they are by no means
‘‘benign’’ in the extent to which they can significantly impair women’s health, and
therefore quality of life. Hysterectomy is the commonest major gynaecological oper-
ation, and fibroids are the commonest indication for this operation which, although
often very successful, is not without significant morbidity, mortality and cost. The ad-
ventof newer treatment modalities such as minimally invasive (laparoscopic) myomec-
tomy, uterine artery embolization (UAE) or magnetic resonance-guided focussed
ultrasound surgery (MRgFUS) is not just recognition of the need to preserve fertility
in a select group of women, but reflects the fact that women require and deserve
choice beyond a hysterectomy or conventional myomectomy. Although now widely
used, UAE has yet to be rigorously evaluated, while MRgFUS requires sophisticated
open MRI facilities that are available in a tiny fraction of centres – thus women’s
choices remain very limited.
It is perhaps especially remarkable that in the 21st century we still do not have
a medical treatment for fibroids that could be regarded as both effective and
‘‘stand-alone’’.
In the industrialized western world women are increasingly putting off child
bearing to their mid-to-late thirties: this means that many will have developed fi-
broids, and could face fertility problems or pregnancy complications related to
the fibroids. The need for a better understanding of the biology of fibroids, and
the development of effective and cheap treatment modalities, has never been
greater.
In this Volume, twelve chapters have been put together which cover, in a highly
up-to-date fashion, the current state of knowledge about fibroids, from the molec-
ular basis of the racial disparity seen in the incidence of fibroids, through dis-
courses on what we know or do not about the aetiology and prevalence,
through to different modalities of treatment and their effectiveness. Personally, I
have thoroughly enjoyed editing these contributions, and am very grateful to all
the authors who have given of their time so generously to produce work of
such clarity. Each chapter is extensively referenced, and the material is state of
the art. I hope you, the reader, will enjoy this Volume as much as I have, but above
all I hope clinicians and scientists will be enthused to focus their research energies
on this area of pathology that still remains very much virgin territory. A more ro-
bust evidence base is needed for the better and more effective treatment of
women afflicted by this common, albeit benign, disease.

Isaac Manyonda

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