Medically reviewed by Kim Langdon Cull, retired OBGYN, written by Dr. Jyothi Shenoy, MD
Fibroids, also known as uterine leiomyomas, are non-cancerous growths that develop in or around the uterus. While common during reproductive years, fibroids can undergo significant changes during menopause due to hormonal shifts.
Understanding how menopause affects fibroids, what to monitor, and when to seek medical advice is essential for maintaining uterine health and overall well-being.
What Are Fibroids?
Fibroids are composed of muscle and fibrous tissue and vary in size, ranging from tiny, undetectable growths to large masses that can distort the uterus. They are most commonly influenced by estrogen and progesterone, two hormones that regulate the menstrual cycle.
The Hormonal Shift After Menopause
Hormonal Changes and Fibroid Growth
Menopause brings a significant decline in estrogen and progesterone levels, which typically causes fibroids to shrink or stabilize. Without these hormones fueling their growth, many women experience a reduction in symptoms such as heavy bleeding, pelvic pain, and pressure.
Persistent Symptoms
In some cases, fibroid-related symptoms persist after menopause. This may occur if:
- Menopause Hormone Therapy (MHT) is used, as it can stimulate fibroid growth. However, the effects of hormone treatment can vary and are often statistically insignificant in many cases.
Newer selective estrogen receptor modulators like raloxifene, which exhibit tissue-specific estrogen agonistic and antagonistic actions, show a more favorable clinical profile compared to MHT. These may serve as better alternatives for women with asymptomatic fibroids.
- Certain fibroids remain large enough to cause symptoms even without hormonal stimulation.
- Rarely, fibroids may degenerate and cause pain or other complications.
- New symptoms may occur. While fibroids usually shrink, new symptoms such as unexpected bleeding or pelvic pain should not be ignored. These could signal other conditions, such as uterine cancer, that require immediate medical attention.
Why It’s Important to Monitor Fibroids During Menopause
Changes in Symptoms
As hormone levels decline, you may notice a change in the nature and severity of symptoms. Persistent or worsening symptoms should be evaluated. Since it can be difficult to determine exactly when menopause happens if you have bleeding fibroids, it’s best to have any bleeding evaluated that is heavier or changes in any way. An FSH test can help confirm menopausal status when fibroid bleeding makes the picture unclear.
Rare Complications
Although rare, fibroids can lead to complications after menopause. For instance, a fibroid may outgrow its blood supply, leading to degeneration and acute pain.
Differentiating Between Fibroids and Other Conditions
Post-menopausal bleeding or pain is not normal and should always be investigated. While fibroids are benign, these symptoms can mimic more serious conditions, including endometrial hyperplasia or cancer.
Conclusion
Menopause typically causes fibroids to shrink as estrogen and progesterone decline, and most women see their symptoms ease as a result. Still, fibroids don’t disappear for everyone, and new or worsening symptoms after menopause — particularly bleeding — are never something to dismiss. Keeping up with regular check-ups and reporting any changes promptly is the best way to stay ahead of complications and rule out more serious conditions.
Always consult your healthcare provider if you notice unusual symptoms or have concerns about fibroids during menopause.
References
- De La Cruz, M. et al. (2017). Uterine Fibroids: Diagnosis and Treatment. American family physician, 95(2), 100–107.
- Stewart, E. A. et al. (2016). Uterine fibroids. Nature reviews. Disease primers, 2, 16043. https://doi.org/10.1038/nrdp.2016.43
- Ulin, M. et al. (2020). Uterine fibroids in menopause and perimenopause. Menopause (New York, N.Y.), 27(2), 238–242. https://doi.org/10.1097/GME.0000000000001438
- Srinivasan, V. et al. (2018). Hormone therapy in menopausal women with fibroids: is it safe?. Menopause (New York, N.Y.), 25(8), 930–936. https://doi.org/10.1097/GME.0000000000001105
- Palomba, S. et al. (2001). Effects of raloxifene treatment on uterine leiomyomas in postmenopausal women. Fertility and sterility, 76(1), 38–43. https://doi.org/10.1016/s0015-0282(01)01849-0
- Shrestha, R. et al. (2015). Fibroid degeneration in a postmenopausal woman presenting as an acute abdomen. Journal of community hospital internal medicine perspectives, 5(1), 25917. https://doi.org/10.3402/jchimp.v5.25917
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Overview: Uterine fibroids. [Updated 2021 Jun 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279535/