Fibroids after Menopause: What You Should Know

Not all fibroids are the same. Some are quite small and undetectable without magnification. Others, however, can grow into large masses similar in size to a grapefruit. Studies suggest between 70% and 80% of women will develop fibroids; however, not all require treatment.

What are fibroids?

A uterine fibroid is a growth that occurs in or around the uterus. Fibroids are (almost always) noncancerous but, depending on their size, can impact the size and shape of the uterus. You may hear fibroids referred to as myomas or leiomyomas. It is possible to have one fibroid or multiple at the same time. If someone has too many fibroids, it can affect the size of the uterus to the extent that it touches the rib cage and causes weight gain.

Fibroid development during different stages

Fibroids are among the most common gynecologic conditions. Most women with fibroids are unaware as they do not experience symptoms, and the fibroids are too small to detect during an annual pelvic exam. However, as women age and menopause leads to hormone change, the growth rate and discomfort associated with fibroids can change.

Premenopause

Fibroids are the most common in women during their childbearing years. This means when someone is premenopausal and perimenopausal, fibroids are more likely to grow. Studies suggest fibroids are more common in these groups because estrogen and progesterone affect the growth of fibroids. Research also suggests that premenopausal women may experience more severe symptoms than those closer to or in menopause.

Perimenopause

Perimenopause is the term that describes the time “around” or just before menopause occurs. Unlike premenopause, perimenopause signals the beginning of changes to your body related to menopause. One such change is an increase in estrogen in the months or years just before menopause. Because estrogen is connected to the growth of fibroids, perimenopausal women may find that their fibroids worsen during this time.

Menopause and post-menopause

During menopause, the levels of estrogen in the body decline. When levels of estrogen decrease, your menstrual cycle stops, and other effects of menopause begin. One benefit to menopause for some women is that reduced estrogen levels may also prevent the growth of new fibroids and potentially reduce the size of existing ones. Although fibroids and related symptoms can still grow during menopause and post-menopause, it is not as common.

Fibroid symptoms

Uterine fibroids typically affect women of childbearing age (premenopause and perimenopause); however, menopause is not necessarily a "cure." Due to estrogen levels in the body before menopause, premenopausal women are more likely to experience more severe symptoms. The symptoms of fibroids after menopause can be similar to those that occur during pre- and perimenopause. For example:

• Severe cramping (similar to menstrual pain).
• Pain during intercourse.
• Swelling or fullness in the abdomen.
• Problems with urination (frequency, leakage).
• Heavy bleeding.
• Lower back pain.
• Frequent spotting.
• Fever.
• Headaches.
• Nausea.

What happens to fibroids during and after menopause?

When a woman enters menopause, her fibroids may change. Several factors related to menopause control what happens to fibroids after menopause begins.

Can fibroids grow after menopause?

Without estrogen, fibroids cannot grow. Because estrogen levels decline significantly during (and after) menopause, most fibroids shrink and cause fewer symptoms. However, this is not the case for all women leading to the question, “what causes fibroids to grow after menopause?” Women who use hormone replacement therapy to maintain estrogen and progesterone levels may find their fibroids continue to grow even after menopause.

Can fibroids cause bleeding after menopause?

It is possible to experience fibroid spotting after menopause. Again, this is a symptom that is often connected to hormone replacement therapy after menopause because HRT provides the hormones needed for the fibroid to continue growing.

Can fibroids cause cancer after menopause?

Statistics suggest that approximately 99% of fibroid cases are not cancerous and that fibroids after menopause do not increase uterine cancer risk.

Can fibroids cause pain after menopause?

Fibroids can cause pain and discomfort in women after menopause. This can occur due to fibroids continuing to grow with the introduction of hormones through HRT or due to calcification. Once fibroids reach the end of their normal life cycle, they will calcify (shrink and harden). Calcified fibroids after menopause can be another source of postmenopausal fibroid pain.

Fibroid treatment options

Treatment options for fibroids often vary depending on your symptoms. If you are approaching menopause and your fibroids do not cause any adverse symptoms, your doctor might recommend a “watch and wait” approach. However, if fibroids are painful or if they cause other medical health effects, there are several possible medical treatments for fibroids after menopause.

Hormone therapy

Birth control pills are a preferred treatment option for fibroids after menopause. Although birth control pills will not shrink or eliminate fibroids, they can help reduce pain and bleeding related to fibroids.

Myomectomy

A myomectomy is a procedure that targets the fibroid without removing the uterus. Depending on your symptoms, the location of the fibroid, the size of the fibroid, and how many fibroids you have, a myomectomy might be preferred before considering a hysterectomy. Often, the procedure is performed laparoscopically, allowing for a shorter recovery time. Should fibroids return, your provider may recommend a hysterectomy.

Hysterectomy

A hysterectomy may be the best treatment option for severe fibroid symptoms due to recurring or large fibroids. During a hysterectomy, your provider removes all or part of the uterus. A hysterectomy is favored for women with very large fibroids who have tried other treatments without success and those outside of childbearing age. There are three types of hysterectomy that are differentiated based on the surgical effect on the uterus and other pelvic organs. A hysterectomy is the only way to cure fibroids, and nearly 300,000 women annually have a hysterectomy to relieve fibroid symptoms.

Are there natural fibroid treatment options after menopause?

If fibroids are mild and cause minimal symptoms, natural or “at-home: treatment may help relieve your symptoms. Talking to your provider about your symptoms is essential to ensure a treatment or remedy is right for you. Examples of possible natural treatments for fibroids after menopause could include lifestyle changes such as:

• Weight loss.
• Eating a nutritious diet (limit refined carbohydrates, sugars, and processed foods).
• Vitamins and supplements.
• Herbal remedies.
• Stress reduction and self-care tools.
• Green tea.
• Traditional Chinese medicine.

Although fibroids are most common before menopause, they can occur throughout a woman’s lifetime. If menopausal fibroids cause pain or discomfort, talk to your medical provider about the best treatment options for you.