Fibroids and menopause
What you need to know about managing fibroids before and after menopause
- Approximately two in three women will develop at least one fibroid at some point in their life
- How menopause can affect fibroids
- Advice about HRT if you have a history of fibroids
Fibroids are non-cancerous growths that develop in or around your womb and are made up of muscle and fibrous tissue. Most women with fibroids do not experience any symptoms, but some may experience symptoms such as heavy or painful periods, abdominal discomfort or lower back pain.
The exact cause of fibroids is unknown, but they have been linked to the hormone oestrogen, with fibroids usually developing during your reproductive years when oestrogen levels are at their highest [1].
How common are fibroids?
About two in three women will develop at least one fibroid at some point in their life, most commonly between the ages of 30 and 50 [1]. A US ultrasound-based screening study of women aged 35-49 years found that 51% of premenopausal women, with no previous diagnosis, had ultrasound evidence of fibroids [2].
What are the symptoms of fibroids?
Symptoms can depend on a number of factors, including:
- The number of fibroids you may have
- Their size
- Their position within your womb [3].
Fibroids that are small and located in areas that do not affect the uterine cavity often do not cause any symptoms. However, larger fibroids can cause particularly heavy periods, which can be painful. Some women experience abdominal or back pain with the bleeding, and other symptoms include constipation and frequent urination.
RELATED: Heavy periods during perimenopause: what you need to know
What are the different types of fibroids?
Intramural fibroids are the most common type of fibroids and develop within the muscle of the womb.
Submucosal fibroids are fibroids that grow in the muscle layer of the womb beneath the inner lining of the womb. These are more likely to cause heavy or prolonged periods with some bleeding in between periods.
Subserosal fibroids are fibroids that grow outside the wall of the uterus into the pelvis, these can cause pressure on the bladder and rectum with symptoms of frequent urination and constipation.
It’s also important to distinguish fibroids from other conditions such as endometrial hyperplasia (an abnormal thickening of the lining of the womb) or even cancers. Regular check-ups and imaging studies can help in accurate diagnosis.
RELATED: Endometrial hyperplasia explained
How does menopause impact fibroids?
Fibroids usually develop when you are younger and tend to shrink with age. This may be related to reducing hormone levels.
What’s the treatment for fibroids?
For younger women, fertility preservation is often a key consideration in fibroid management, which influences treatment choices. In contrast, post-menopausal women typically have a broader range of treatment options, as fertility is not a concern.
Treatment for fibroids if you are over 50 may include medications to manage symptoms, minimally invasive procedures such as uterine artery embolisation, or, in some cases, surgery. The choice of treatment depends on the size and location of your fibroids, symptom severity, and your overall health status.
Can I take HRT if I have fibroids?
Women with fibroids who are on HRT may have unique considerations. HRT alleviates menopausal symptoms and offers health benefits such as reduction in cardiovascular risk and supporting bone health. However, in some women with fibroids, the re-introduction of oestrogen can lead to growth of fibroids that had shrunk. In some women, this can result in a return of fibroid symptoms.
One of the common symptoms of fibroids is abnormal uterine bleeding, which might be exacerbated by HRT. If you know you have fibroids, the potential impact of starting HRT should be discussed with you, and if symptoms return.
There may be a need to adjust your HRT regimen – this might involve using a lower dose of oestrogen or increasing the dose progestogen to counteract the effects of oestrogen on the uterus. Testosterone does not usually impact fibroids.
Monitoring and evaluation
Women with fibroids who are taking HRT may require closer monitoring if symptoms return. This can include regular examinations and ultrasounds to assess the size of the fibroids and any changes in symptoms.
It’s important to note that the response to HRT can vary significantly among individuals. While some women with fibroids may experience more fibroid symptoms due to HRT, others may not notice any changes.
What else can help fibroids?
A balanced diet rich in fruits, vegetables, and whole grains, along with regular exercise, can be beneficial. Maintaining a healthy weight can help in managing fibroid symptoms. Avoiding high-fat and processed foods is also recommended. You can read more about exercise and nutrition in perimenopause and menopause in the balance app.
RELATED: Living well through your perimenopause and menopause
Written by Mr Osama Naji and Dr Penny Ward
Osama Naji is a Consultant Gynaecologist at Guy’s and St Thomas’ NHS Foundation Trust, where he leads the Rapid Access Service for Cancer Diagnostics at Guy’s Cancer Centre. You can read more about Mr Naji here.
References
1. NHS Fibroids
2. Baird D.D., Dunson D.B., Hill M.C., Cousins D., Schectman J.M. (2003), ‘High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence’ Am J Obstet Gynecol, 188(1) pp100-7. doi: 10.1067/mob.2003.99
3. NICE (2023) Fibroids
