What You Need to Know About Fibroids After Menopause

Uterine fibroids often decrease after menopause when progesterone and estrogen levels drop, but not always. Fibroids may shrink once you reach the end of your childbearing years, but they can still cause symptoms such as bleeding and pain.

Even though uterine fibroids are classified as tumors, they are almost always noncancerous. Fibroids are something almost every woman experiences. In fact, researchers estimate that 70% to 80% of all women will have a fibroid at some point in their lifetime.

Some women will never be aware of uterine fibroids because they have no symptoms. They may only find out about a fibroid by accident while undergoing another procedure. Other women with fibroids will struggle with abnormal menstrual cycles, fertility issues, and pain.

This article will discuss symptoms of fibroids after menopause, risk factors, and treatment options.

What Are Fibroids?

Fibroids are made of muscle and fibrous tissue and can vary in size. The hormones progesterone and estrogen affect the size of the fibroid and the rate at which it grows.

Fibroids can appear in various places in the uterus (womb). These growths can occur in the lining of the uterus, the muscle layer surrounding the uterus, and the outer layer. They can also be free-floating on the outside of the uterus, attached by a stalk-like stem.

Fibroids are classified as benign tumors. It is very rare for a fibroid to become cancerous.

How Are Fibroids Connected to Hormones?

Fibroid growth is fairly straightforward. In order to grow, the fibroid needs to be fed by hormones like estrogen and progesterone. These hormones are at their highest levels during premenopause, the time between a person's first period and the onset of perimenopause.

Perimenopause is the transitional period leading up to menopause. This phase commonly starts in your early 40s and lasts up to 10 years. During this phase, the ovaries produce fewer hormones, and periods become irregular. Since the ovaries are still producing estrogen and other hormones, however, it’s still possible to become pregnant or have estrogen trigger fibroid growth.

When a woman has gone without a period for 12 months (excluding pregnancy and disease conditions), she has reached menopause. The average age of menopause in the United States is 52.

The postmenopause period is the period after a woman has gone through menopause. At this stage, the hormonal fluctuations tend to be less drastic and stay at a consistently low level. Most fibroids will shrink during menopause when estrogen levels decline. However, this is not the case for all women.

Risk Factors

The following are a few risk factors that increase the possibility of fibroids during and after menopause:

• High blood pressure
• Vitamin D deficiency
• Obesity
• High levels of stress
• Family history of fibroids
• No history of pregnancy
• Being African American (Black women are two to three times more likely than Whites to experience fibroids)

Symptoms

Regardless of your age or whether you’re in menopause or not, fibroid symptoms remain the same. Some of the more common symptoms are:

• Abnormal uterine bleeding
• Abdominal cramping
• Pain during sex
• Low back pain
• Feeling of pain or pressure in the pelvis
• Pressure on the bladder or bowels causing more frequent trips to the bathroom

Some women with fibroids have no symptoms. They may only find out about a fibroid while undergoing another procedure.

Treatment

There are numerous options for treating fibroids, some more invasive than others. These include:

Hormones

Depending on your age and the severity of your fibroid symptoms, your healthcare provider may try to treat your fibroids using a type of hormone therapy.

Types of hormonal therapies include:

• Hormonal birth control, including pills and IUDs that release progestin. These can reduce heavy and painful bleeding but do not treat the fibroids themselves.
• Gonadotropin-releasing hormone agonists (GnRHa). These medications prevent the body from making the hormones that cause women to ovulate and menstruate. The medicines also reduce the size of fibroids.
• Antihormonal agents or hormone modulators (such as selective progesterone receptor modulators). These drugs, which include ulipristal acetate, mifepristone, and letrozole, can slow or stop the growth of fibroids, reduce bleeding, and improve symptoms.

If additional treatment is needed, your healthcare provider may prescribe alternative medications, such as Lupron Depot (leuprolide acetate), that can help shrink the fibroid.

Myolysis

Myolysis is a procedure that shrinks fibroids using a laser, extreme cold, an electric current, or high-frequency ultrasound. While it is not a permanent solution, it is less invasive than surgical methods used to treat fibroids. Myolysis is not recommended for pregnant women, as it can cause scarring in the uterus.

Uterine Fibroid Embolization 

Uterine artery embolization (UAE or UFE) is a procedure in which a tube (catheter) is inserted via a cut in the groin area into a large blood vessel that supplies the uterus. Next, the healthcare provider injects tiny plastic or gel particles through the tube. These particles block blood flow to the fibroids, relieving symptoms and causing them to shrink.

Myomectomy

During a myomectomy, fibroids are surgically removed from the uterus and then the walls of the uterus are repaired. It leaves the healthy areas of the uterus intact.

A myomectomy can be done laparoscopically, via a laparotomy, or by hysteroscopy.

A laparotomy is a procedure that involves making a small incision in the wall of the abdomen. During the procedure, a long, slender camera and surgical instruments are inserted through the incision into the abdominal cavity. During a hysteroscopy, a long, slender camera and surgical instruments are inserted through the cervix into the uterus itself.

Electricity or a mechanical device is used to cut or destroy the fibroids.

Hysterectomy

A hysterectomy is a surgical procedure in which the uterus is removed. In some cases, the ovaries are removed as well. A hysterectomy is the only way to remove fibroids permanently in women who are not planning to become pregnant.

There are several types of hysterectomy procedures:

• Vaginal hysterectomy, in which the uterus is removed through the vagina
• Abdominal hysterectomy, in which a six- to eight-centimeter incision is made in the abdomen
• Laparoscopic hysterectomy, in which the uterus is removed through multiple, tiny incisions in the lower abdomen using a laparoscope

Outlook

The outlook for women with fibroids depends largely on how severe they are and which treatment is used to manage or remove them. Unless they are treated with a hysterectomy, fibroids can grow back. That said, because of the drop in hormone levels in menopause, fibroids may shrink and not require treatment at all.

Summary

Uterine fibroids affect up to 80% of women in the United States. Women are most likely to develop fibroids in their childbearing years when the hormones estrogen and progesterone are at high levels. These levels drop during menopause. As a result, fibroids may shrink. Some women, however, continue to experience symptoms of fibroids.

Treatments for fibroids range from hormone replacement therapy to surgery, including hysterectomy.