Fibroids, also known as uterine leiomyomas, are noncancerous growths that develop in the uterus. They are quite common, with as many as 80% of women developing them by the age of 50. While fibroids are more common in women of reproductive age, it is still possible for an older woman to experience them. Today we are going to talk about the increasing prevalence of uterine fibroids in older women, fibroids after menopause, and some interesting findings that were discovered in recent studies.
Is There An Age Limit For Having Fibroids?
Fibroids are more common in women who are in their mid to late reproductive years, typically between the ages of 30 and 50. Research has shown that for most women, fertility begins to decline after age 35, and by age 45, it is highly unlikely to become pregnant naturally. However, it is possible for women to develop fibroids after menopause. Menopause is the point at which a woman’s menstrual periods have stopped for 12 consecutive months, indicating the end of her reproductive years.
After menopause, the production of estrogen in the body decreases significantly. Since fibroids rely on estrogen to grow, they typically shrink or disappear after menopause. However, in some cases, fibroids may continue to grow even after menopause, although it is unclear why this occurs. It may be due to the fact that the ovaries continue to produce small amounts of estrogen even after menopause.
Other Factors That Increase The Risk Of Fibroids
There are several other factors that can increase a woman’s risk of developing fibroids. These include family history, obesity, exposure to xenohormones that imitate estrogen, a diet high in red meat and low in fruits and vegetables, and vitamin D deficiency. African American women are also at higher risk of developing fibroids.
Fibroids Can Cause Serious Symptoms Or None At All
Symptoms of fibroids can include heavy menstrual bleeding, prolonged periods, pelvic pain, frequent urination, constipation, and back pain. In some cases, fibroids may not cause any symptoms at all and may only be detected during a routine pelvic exam or imaging test.
Fibroids In Older Women
Although fibroids normally affect younger women, recent studies have revealed some interesting findings regarding uterine fibroids in older women.
To understand the changes in symptoms of fibroids after menopause, it’s important to clarify the following terms: premenopause, menopause, and postmenopause.
Premenopause is generally the entire reproductive period in a woman’s life.
Menopause (or perimenopause) is a transition time between a woman’s reproductive and non-reproductive ages, when estrogen dominancy drops.
Postmenopause is a period of a woman’s life when ovaries stop producing estrogen and progesterone and releasing eggs. In other words, a woman can’t become pregnant naturally.
Fibroids After Menopause
Previous studies have indicated that the prevalence of fibroids that are symptomatic tends to peak during perimenopause but then declines as menopause sets in. But some recent studies have shown that healthcare professionals may need to change their thinking about fibroids in older women.
A study conducted in California with 1,790 teachers showed that over thirty percent of the women who were newly diagnosed with fibroids were in their mid- to late-forties. This indicates a possible shift in what was once believed about fibroids and which age groups of women are most likely to experience them.
Another study of interest was published by the North American Menopause Society, and conducted on a group of 102 postmenopausal women from 2015 through 2020. The study observed and tracked active fibroid growth in these older patients through vaginal ultrasound at six-month intervals.
It was observed that growth occurred in smaller fibroids more frequently than in larger ones, and obese women experienced twice the amount of fibroid growth as those with healthy BMIs.
The two noteworthy facts about the findings of this study are:
- The research concentrated on fibroids in older women of Asian descent in Beijing, China, where the incidence of fibroids is very low;
- The smaller fibroids and not the larger ones experienced the most growth, which was not expected by the researchers.
More Research Is Needed Regarding Uterine Fibroids In Older Women
The findings of this recent study indicate that it is important for healthcare providers to not discredit the presence of fibroids only because of a woman’s age.
The United States has a much higher prevalence of fibroids than China, and African American women have the highest prevalence, although none were included in this study. Connecting the dots, one could conclude that the incidence of women with fibroids after menopause in the United States is much higher than once believed.
A similar study using a more diverse population in the United States would be beneficial to help further our knowledge regarding this very common women’s health issue.
Hormones and Fibroid Symptoms in Postmenopause
Fibroid symptoms that are dependent on hormones are usually no longer a problem for a woman with fibroids after menopause.
Normally, symptoms like bleeding and pelvic pain from fibroids no longer affect a woman after menopause.
Estrogen
The high estrogen levels before menopause make the uterus lining thick and rich with blood to accommodate a fertilized egg. After menopause, estrogen levels drop significantly lower, which normally stops all the bleeding. Any postmenopausal bleeding should be reported to your OB/GYN to rule out more serious issues like cancer.
Progesterone
Progesterone is responsible for managing uterine contractions. Before menopause, the level of progesterone is higher during the second half of a woman’s cycle, when the uterus “sheds” its lining that failed to accommodate a fertilized egg, or simply no fertilization happened.
Many women experience normal menstrual cramps at this time as the lining sheds, but a woman with fibroids might experience severe cramps before menopause. After menopause, the progesterone levels are low and won’t cause cramping or pelvic pain from fibroids.
Some symptoms caused by fibroids after menopause may not resolve, such as pelvic pressure caused by large fibroids in the uterus. The deficiency of estrogen stops fibroids from getting bigger but rarely causes shrinkage of any existing tumors. Large fibroids remain large and heavy, and bulk-related symptoms, such as pelvic pressure, an enlarged uterus, and frequent urination might not go away.
Treatment For Older Women With Fibroids
Often, peri-menopausal women who have only mild fibroid symptoms are advised to try to wait it out until they reach menopause, with the understanding that these symptoms may go away on their own.
Menopause occurs on average at age 51, but the waiting game can be highly frustrating for women with aggravating symptoms like heavy bleeding, pelvic pain, painful intercourse, or urinary frequency. In menopause, bleeding symptoms will typically improve or disappear, however, some bleeding related to fibroids can still be seen in women who are using hormone replacement therapy after menopause.
We also know that new fibroids will stop forming and existing fibroids may decrease in size by a small amount over time. However, fibroids do not disappear after menopause, and medium to large fibroids can continue to cause pelvic pain, pelvic pressure, painful intercourse, and, most commonly, frequent urination well into women’s 50’s and 60’s.
If their symptoms are affecting their quality of life, the OB-GYN will usually suggest a hysterectomy. The general line of thinking is that these women are past their childbearing years, so they no longer need their uterus.
However, in 2013, a landmark paper in the Journal of Women’s Health demonstrated that most of the roughly 1,000 women surveyed with symptomatic fibroids did not want any surgical option. Instead, they chose to just suffer with the symptoms. Many women had planned to live with the miserable symptoms and wait for menopause, hoping their symptoms would improve. There are over one million women in the US we refer to as the “silent sufferers”. They don’t want surgery, but are unaware of the nonsurgical, outpatient option Uterine Fibroid Embolization (UFE).
Also, in recent years, research has discovered links between a woman’s uterus being removed and many other women’s health-related conditions, such as cardiovascular disease and cognitive decline. A hysterectomy can also impact sexual function, increase the risk of urinary incontinence and bowel problems, and elevate the risk of developing depression and anxiety. A hysterectomy should be avoided and only pursued if medically necessary.
Uterine Fibroid Embolization: A Better Option Than Surgery
Older women with fibroids should consider uterine fibroid embolization (UFE) as a first line of treatment. UFE is a minimally invasive procedure used to eliminate fibroids and can address all types and sizes of fibroids, regardless of their location in the uterus.
During the procedure, a small catheter is used to inject small particles into the uterine artery that block the blood supply to the fibroids, causing them to shrink and alleviating symptoms such as heavy menstrual bleeding, pelvic pain, and urinary frequency.
UFE is typically performed by an interventional radiologist and is considered a safe and effective alternative to surgical treatments such as myomectomy (surgical removal of fibroids) and hysterectomy (surgical removal of the uterus). It is associated with a shorter recovery time and fewer complications.
Patients do not need to stay in the hospital and only have one bandaid when they are released as evidence of their procedure. Most women are back to their normal schedule in a week and within a few months are free from their debilitating fibroid symptoms.
Who Can Help An Older Woman Eliminate Fibroids?
The Atlanta Fibroid Center, located in Smyrna, Georgia, specializes in the treatment of uterine fibroids and is led by Dr. John C. Lipman, a board-certified interventional radiologist with over 25 years of experience in the field. Dr. Lipman is a recognized leader in the field of UFE and has performed thousands of procedures, earning him the distinction of being one of the top UFE providers in the country.
Dr. Lipman and a team of highly skilled professionals provide personalized care to each patient, assessing the individual’s medical history and recommending appropriate treatment options based on their unique situation.
UFE has helped countless women reclaim their quality of life and is a safe and effective treatment for patients of any age. If you are an older woman with fibroids, consider UFE for treatment before you agree to a surgical solution.
We urge you to contact the Atlanta Fibroid Center and set up an appointment to learn more about this non-surgical 45-minute procedure that could give you your life back.
