What to know about fibroids after menopause

Fibroids, also called uterine myomas or leiomyomas, are noncancerous growths that develop in the muscular wall of the womb or uterus.

Fibroids are common, especially during premenopause. They can affect nearly 70–80% of females at some point in their lives.

For many people, fibroids grow when hormone levels are high, such as during pregnancy. They tend to shrink when the body stops producing high levels of hormones, such as after menopause.

Language matters

Sex and gender exist on a spectrum. We use the term “female” in this article to reflect the term assigned at birth. However, gender is solely about how you identify yourself, independent of your physical body. 

How uterine fibroids decrease after menopause

The body produces less progesterone and estrogen during menopause. As fibroids need these hormones to develop, the decreasing levels typically lead to fewer fibroids once a person reaches menopause.

However, while menopause may decrease the severity of fibroid symptoms, it may not prevent new growth.

Symptoms of uterine fibroids

Fibroids can vary in size, from the size of a pea to the size of a melon. Some people may not have any symptoms and not know they have fibroids.

When symptoms do occur, they can include:

• heavy bleeding, which may cause anemia
• swelling in your lower abdomen
• pain or feeling of fullness in your pelvic area
• pain in your lower back
• a frequent need to urinate
• pain or discomfort during sex

How doctors diagnose uterine fibroids

If you think you have fibroids, you should visit your doctor. Your doctor may perform a pelvic examination to confirm whether or not you have fibroids.

Alternatively, your doctor may refer you for tests or procedures, such as:

• ultrasound
• MRI
• CT scan
• X-ray
• hysterosalpingogram (HSG)
• sonohysterogram
• laparoscopy
• hysteroscopy

Your doctor can advise on any tests or procedures they order and what they involve.

Risk factors for uterine fibroids

Some risk factors can increase your chance of developing fibroids. They include:

• High blood pressure (hypertension): Studies indicate that people with hypertension are up to 40% more likely to have uterine fibroids.
• Low vitamin D levels: A small-scale study of 69 participants showed that vitamin D decreased the size of uterine fibroids by an average of 7.14 millimeters (mm).
• A family history of fibroids: People are three times more at risk of developing fibroids if their parent has experienced uterine fibroids.
• Obesity: A case-control study suggests that obesity causes changes in the endocrine system function and hormones, especially estrogen, and can increase the risk of uterine fibroids.
• Long-term extreme stress: Stress may cause fluctuations in estrogen and progesterone hormone levels, which may increase the risk of fibroids.
• Race: Based on clinical diagnoses, uterine fibroids are more common in Black females than white females.
• Diet: A 2021 review found mixed evidence that a diet high in fat, meat, fish, alcohol, and coffee increases the risk of uterine fibroids. However, a diet rich in fruit and vegetables may decrease the risk of uterine fibroids.

Treatments for uterine fibroids

If you do not experience any symptoms with uterine fibroids, treatment may not be necessary. However, in cases where uterine fibroids cause uncomfortable or life-altering symptoms, your doctor may recommend different treatments.

Medication

If the fibroids are causing pain, your doctor may recommend medication such as a gonadotropin-releasing hormone agonist (GnRH) (Lupron), which can shrink fibroids by decreasing gonadal hormone production.

Other treatments, such as oral contraceptives or an IUD, may help alleviate fibroid symptoms and can control heavy bleeding. Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or pain relievers, such as acetaminophen may help relieve cramps.

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Surgery

Your doctor may recommend surgery if fibroids are large or if they are causing you severe discomfort. You should speak with your doctor regarding the advantages and disadvantages of each surgery option before deciding which procedure is best.

Endometrial ablation

This procedure is suitable for people whose main symptom is heavy or abnormal bleeding. An endometrial ablation destroys the lining of the uterus, reducing bleeding.

Uterine artery embolization

This is a minimally invasive procedure. A uterine artery embolization cuts off the blood supply to the fibroids, which causes them to shrink.

Myomectomy

A myomectomy may be an effective treatment option if you wish to avoid a hysterectomy. This procedure removes the fibroids but preserves the healthy tissue of the uterus. However, fibroids may grow back after a myomectomy.

Myolysis

Myolysis involves inserting a thin needle into the fibroids and destroying them either with an electric current or by freezing them.

Hysterectomy

A hysterectomy may be an option when other forms of treatment have not been successful.

A hysterectomy can either be partial, where the surgeon removes the uterus but leaves the cervix in place, or total, where the surgeon removes the uterus and cervix completely.

It is best to speak with a doctor to decide which treatment option is the most suitable for you.

Summary

Uterine fibroids can develop at any time. While changes in hormone levels may make them less likely to develop after menopause, they can still develop.

Some people do not experience symptoms with fibroids. Symptoms that may develop include swelling, pain, and frequent urination.

A doctor may recommend medications for managing symptoms of fibroids. If symptoms persist, surgery may be an option. It is best to discuss treatment options with a doctor.

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