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Uterine fibroids are benign growths that develop from the muscle and connective tissue in the uterus, leading to a range of symptoms. Menopause expert and board-certified OB/GYN, Dr. Beverly Joyce explains that these growths are influenced by hormones, particularly estrogen and progesterone, which can be a significant consideration for those contemplating hormone therapy during menopause. It’s believed that up to 70–80% of women will develop uterine fibroids by age 50.
Symptoms can include abnormal uterine bleeding, a sensation of fullness, pressure, or pain in the pelvic area, and potential impacts on fertility. While many fibroids remain small and asymptomatic—often discovered only during routine medical exams—larger fibroids can disrupt the uterus’s normal operations and exert pressure on surrounding organs, such as the bladder. Fibroids can result in serious symptoms like heavy menstrual bleeding, spotting between periods, frequent urination, challenges in emptying the bladder, abdominal or back pain, constipation, and discomfort during intercourse. Diagnosis primarily involves ultrasound, which offers a detailed image of the body’s interior, though MRIs or other imaging techniques may also be employed to exclude other conditions.
Uterine fibroids typically develop before menopause, during a woman’s reproductive years, when estrogen and progesterone levels are higher. These hormones, especially estrogen, play a crucial role in the growth of fibroids, as they stimulate the development of the uterine lining during each menstrual cycle and can also promote the growth of fibroids. However, the occurrence or growth of fibroids during menopause can be a bit more complex due to the significant hormonal changes that occur.
As a woman enters menopause, the levels of estrogen and progesterone decrease. This decline usually leads to a reduction in the size of fibroids for most women, as the hormonal support for their growth diminishes. However, the hormonal landscape during menopause isn’t uniform for all women, especially for those who opt for menopausal hormone therapy (MHT) to manage menopausal symptoms. MHT provides exogenous hormones, potentially influencing the behavior of existing fibroids due to the reintroduction of estrogen and progesterone into the body.
The exact cause of fibroids is still not fully understood, but factors beyond hormones, such as genetics, age, body weight, and lifestyle, may also influence their development and growth. While fibroids are less likely to be a new issue in menopause, women with existing fibroids or those undergoing hormone therapy should be monitored for changes in fibroid size or symptoms due to the complex interplay of hormones during this phase.
Managing uterine fibroids during menopause involves a personalized approach that considers the size of the fibroids, the severity of symptoms, and overall health. Here are strategies and treatments that can be effective:
Observation: In many cases, especially as estrogen levels decline with menopause, fibroids may shrink on their own. If fibroids aren’t causing severe symptoms, monitoring their size and symptoms over time might be appropriate.
Medications: Non-hormonal medications such as non-steroidal pain relievers and Tranexamic Acid can manage symptoms like pain and heavy bleeding. For those not yet fully in menopause or using hormone replacement therapy (HRT), doctors might adjust treatments to ensure they don’t exacerbate fibroid growth.
Hormonal Treatments: In some cases, hormonal medications that help control the menstrual cycle and reduce heavy bleeding can be effective. However, these are generally used before menopause, as fibroids often shrink after the transition.
Non-Invasive Treatments: Techniques such as MRI-guided focused ultrasound surgery (FUS) use high-frequency sound waves to target and destroy fibroid tissue without a need for incisions.
Minimally Invasive Procedures: Options like uterine artery embolization (UAE) and Laparoscopic (Acessa) or Transcervical (Sonata) Radiofrequency Ablation (RFA) involve cutting off the blood supply to fibroids, causing them to shrink. Hysteroscopic myomectomy can remove fibroids that are within the uterine cavity while preserving the uterus.
Surgical Options: Myomectomy via laparoscopy or an open approach is an option for women who desire to preserve fertility, or who do not want to remove the uterus. In cases where symptoms significantly impact quality of life, a hysterectomy, the removal of the uterus, might be considered. This is typically a last resort when other treatments have failed or fibroids are too large.
Lifestyle Changes: Maintaining a healthy weight, eating a balanced diet rich in fruits, vegetables, and whole grains, and regular exercise can help manage symptoms and improve overall health.
It’s essential to work closely with a healthcare provider to determine the most appropriate approach based on individual symptoms and health goals. Monitoring and managing any menopausal symptoms, especially for those undergoing HRT, is also crucial to ensure fibroids do not continue to grow.
There is no reason to suffer. Get help today. Find a menopause-specific doctor or healthcare expert near you to help support your perimenopause and menopause journey.