Fibroids and the menopause
What you need to know about managing fibroids before and after the menopause
- About two in three women will develop at least one fibroid at some point in their life
- How the 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 perimenopausal women, with no previous diagnosis, had ultrasound evidence of fibroids [2].
Symptoms
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 which are small and located in areas which 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 the perimenopause: what you need to know
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 which 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 which 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 the menopause impact fibroids?
Fibroids usually develop during your reproductive years when oestrogen levels are at their highest. Then as oestrogen levels fall in the perimenopause and menopause, they tend to shrink. In women who have experienced symptoms associated with their fibroids, this can translate into fewer symptoms as the body’s natural hormonal changes results in less troubling symptoms, such as excessive bleeding or pain.
Treatment
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 like uterine artery embolization, 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.
Fibroids and HRT
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 women with fibroids, the re-introduction of oestrogen can lead to growth of fibroids which had shrunk as your own natural oestrogen levels declined. This can result in a return of fibroid symptoms in some cases.
One of the common symptoms of fibroids is abnormal uterine bleeding, which might be exacerbated by HRT. In women with known 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.
Monitoring and evaluation
Women with fibroids who are on HRT may require closer monitoring if symptoms return. This can include regular pelvic exams 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.
Diet and lifestyle
A balanced diet rich in fruits, vegetables, and whole grains, along with regular exercise, can be beneficial. Maintaining a healthy weight helps reduce oestrogen production, which can, in turn, help in managing fibroid symptoms. Avoiding high-fat and processed foods is also recommended. You can read more about exercise and nutrition in the perimenopause and menopause on the balance menopause library, and the balance app.
RELATED: Living well through your perimenopause and menopause
Written by Mr Osama Naji and Dr Penny Ward
References
1. NHS.uk (2022), ‘Fibroids’
2. Johns Hopkins Medicine ‘Fibroids’
3. National Institute for Health and Care Excellence (2022), ‘Fibroids’
