Fibroids (otherwise known as myomas or leiomyomas) are abnormal non-cancerous growths in the uterus. In other words, they are benign uterine tumors. Numerous studies have shown that fibroids are estrogen-dependent. Fibroids tend to regress after menopause when the levels of estrogen drop causing other changes in women’s bodies at the same time. As fibroids regress, their symptoms typically resolve, too. Today, we are going to investigate what happens to fibroids’ symptoms in women after menopause.
Fibroids after Menopause
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.
Generally speaking, a woman enters the postmenopause stage if she has not had a period for the last 12 consecutive months. This is a natural process accompanied by various symptoms all of which are more or less caused by the reduced levels of estrogen.
Hormones and Fibroid Symptoms in Postmenopause
In most cases, hormone-dependent fibroids are no longer a problem for a woman after menopause. New fibroids do not develop, existing ones do not grow. Although with menopause, some of the fibroid symptoms stop, some might remain. Let’s figure out why.
Fibroid bleeding and pelvic pain from fibroids typically no longer bother women after menopause. High estrogen before menopause makes the uterus lining thick and blood-rich to accommodate a fertilized egg. When estrogen is low after the menopause, no bleeding should occur, including fibroid bleeding. Any postmenopausal bleeding should be reported to your Gynecologist to exclude an underlying cancer.
Progesterone is responsible for uterine contractions. Before menopause, the level of progesterone is high in 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. 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.
However, as mentioned above, some symptoms may stay. Pelvic pressure caused by large fibroids in the uterus might remain after menopause. The deficiency of estrogen stops fibroid development but rarely causes shrinkage of existing tumors. Thus, large fibroids remain large and heavy, and bulk-related symptoms, such as pelvic pressure, enlarged uterus, and frequent urination might not go away.
Managing Fibroids After Menopause: Things to Consider
Postmenopause often brings relief from fibroid symptoms to women. However, there are still some risks associated with Hormone Replacement Therapy (HRT) for postmenopausal women with fibroids. If a woman is prescribed HRT to restore levels of estrogen and progesterone in order to minimize the side effects of postmenopause, it might continue stimulating fibroid growth.
Managing symptomatic fibroids after menopause is necessary for some women. Similar to pre-menopausal women, there are two ways to get this done: surgical and non-surgical treatment. Although postmenopausal women generally are not interested in future pregnancies, it’s still best to avoid hysterectomy if possible. There are many risks associated with hysterectomy (exs. bleeding requiring transfusion, nicking important structures like bladder or bowel, infection, blood clots, etc.) while UFE (uterine fibroid embolization) allows women to keep their uterus, avoid the risks and long recovery of surgery, and is highly effective in relieving their symptoms.
Nonsurgical Treatment of Fibroids After Menopause
Uterine fibroid embolization (UFE) is a minimally invasive procedure, which means that there is no general anesthesia, stitches or blood loss that are unavoidable with any surgery. The procedure relies on blocking the blood vessels feeding fibroids and is performed through a tiny nick in the skin at the top of the right leg where you can feel your pulse. It takes significantly less time to perform the UFE procedure and there is a much shorter recovery than surgery. In addition, the patients go home on the same day with a tiny bandaid, without any stitches. Without a blood supply, the fibroids die and gradually shrink over time. Postmenopausal women typically get significant improvement in fibroid symptoms after UFE, and the recovery takes only a few days, not weeks.