How do we expect fibroids to change over time? Well, the natural course of uterine fibroids typically involves a slow growth in size and number of the fibroids as women reach their 30’s and 40’s. Unfortunately, this often comes with gradual worsening of symptoms which may include heavy menstrual cycles, bleeding in between periods, pelvic pain, bloating, urinary frequency, and infertility.
For some women, these symptoms may become the most significant as they enter their 50’s, at the same time that they are approaching menopause. For these women who are seeking treatment and relief, we are often asked, “Do fibroids and fibroid symptoms go away after menopause?”
Do Fibroids And Their Symptoms Go Away After Menopause?
The short answer: fibroids will typically get smaller after menopause, but they do not go away.
Although some fibroid symptoms like heavy menstrual cycles may improve or resolve after menopause, other bulk-related symptoms of uterine fibroids like pelvic pain, abdominal pain, bloating, urinary frequency, and urinary urgency may continue to be a problem after menopause.
The long answer: the age of onset of menopause varies, but the average age in the United States is 51. Menopause begins when a woman has gone 12 consecutive months with no menstrual cycle.
How Do Fibroids Evolve During Menopause?
The transitional time leading up to menopause is called perimenopause. During this time, women experience a gradual decrease in hormone production. Levels of estrogen and progesterone are lower but are still present and can still allow for the continued growth of uterine fibroids.
Fibroid symptoms are likely to continue during this time. As hormone levels decline, periods can become more irregular. Women may skip periods altogether and then experience longer, heavier cycles. This unpredictability can make menstrual cycles even harder to manage. However, longer stretches of missed cycles can be a relief for women whose most significant symptom is heavy bleeding.
For women with pelvic pain, bloating, and urinary frequency, these symptoms may continue or worsen during the perimenopausal period as fibroids continue to grow.
Once menopause has begun, overall hormone production is lower. There are typically fluctuations in estrogen and progesterone levels at this time that can lead to symptoms of menopause, including hot flashes, vaginal dryness, sexual discomfort, night sweats, chills, sleep disturbance, mood swings, and weight gain. Low hormone production will also allow fibroids to stop growing and begin to decrease in size.
How Much Do Fibroids Shrink After Menopause?
How much each fibroid will shrink after menopause can vary widely. It is important to note that fibroids are benign or non-cancerous tumors made from living smooth muscle cells. With lower hormone production in menopause, these cells can get smaller but usually do not die, and there is a limit to how much they can shrink.
Some women with small fibroids may have significant regression in the size of each mass. However, many women with moderate to large fibroids may only have a slight 10-20% decrease in the size of their fibroids after menopause.
Also, some women will be on hormone replacement therapy HRT or use some form of exogenous “extra” estrogen, e.g. vaginal suppositories containing estrogen to combat dryness, painful sex, which can keep symptoms going. For these reasons, women with larger fibroids and bulk-related symptoms like pelvic pain, abdominal pain, bloating, urinary frequency, and urinary urgency will often have persistent symptoms well into menopause.
Although some fibroid symptoms like heavy menstrual cycles may improve after menopause, other bulk-related symptoms of uterine fibroids may continue to be a problem after menopause.
Is Vaginal Bleeding Normal in Post-Menopause Women?
Evaluation of fibroid-related symptoms in any woman who has begun menopause requires careful consideration for cancers of the pelvis, including ovarian cancer, endometrial cancer, and cervical cancer. Although they are relatively uncommon, it is important to have appropriate screening for these types of cancer. In particular, any amount of vaginal bleeding in a menopausal woman is abnormal and requires a thorough evaluation which will typically include a pelvic exam, ultrasound, Pap smear, and an endometrial biopsy.
Abnormal uterine bleeding can sometimes be associated with fibroids after menopause. Occasionally, women who are receiving HRT for menopausal symptoms may have a recurrence of fibroid-related bleeding. HRT can help with symptoms like hot flashes, sleep disturbance, and vaginal dryness, but the presence of hormones can cause fibroids to grow and resume bleeding. Unlike normal menstrual cycles, this bleeding is usually seen in the form of irregular spotting or random stretches of heavier flow. It is often unpredictable and difficult to manage, leading to leakage and accidents.
Treating Fibroids After Menopause
Women who have completed an appropriate evaluation and continue to have fibroid symptoms after menopause may still consider many of the same options for uterine fibroid treatment.
Uterine fibroid embolization (UFE) is a non-surgical, outpatient, minimally-invasive option for treating symptomatic uterine fibroids. This can be safely performed in menopausal women with excellent relief of bulk-related symptoms like pelvic pain, abdominal pain, bloating, and urinary frequency. In the appropriate setting, uterine bleeding related to fibroids and/or hormone replacement therapy can also be resolved with uterine fibroid embolization (UFE).