Hormone Replacement Therapy (HRT) is a treatment that is often used to help relieve the uncomfortable symptoms associated with menopause. As women age, their bodies stop producing enough estrogen and progesterone, which is what triggers symptoms such as hot flashes, night sweats, weight gain, etc.
Some women may be concerned about the effects of HRT and uterine fibroids after menopause because excess estrogen is known to promote fibroid growth. Today we are going to talk about HRT and fibroids and what to consider if you are looking at HRT as a treatment option.
A Bit About Uterine Fibroids
Uterine fibroids are noncancerous growths that develop from muscle tissue in or around the uterus. They may cause no symptoms. Some are linked with heavy bleeding, pelvic pain or pressure, frequent urination, and other changes.
Doctors do not know one single cause for fibroids but estrogen and progesterone appear to influence fibroid growth. Hormones are only part of the picture and family history, health factors, and lifestyle may also matter.
Women are exposed to large amounts of excess estrogen every day and may not even be aware of it. Many foods and household products contain ingredients that mimic the effects of estrogen in our bodies and may cause existing fibroids to grow larger. Some women learn they have fibroids during pregnancy. During the first several months of pregnancy, estrogen levels significantly increase and can cause existing fibroids they may not even have known about, to grow enough that they are detected by the OB/GYN during a routine checkup or if they begin causing symptoms.
Fibroids often shrink after menopause as hormone levels fall, but any new symptoms or bleeding after menopause should be evaluated by your doctor. An exam and imaging may be needed to find the root cause and determine whether treatment is needed.
Can HRT Cause Fibroids?
You may be concerned about the effects of HRT and uterine fibroids after menopause because hormone replacement therapy often includes treatments that are heavy with estrogen.
HRT therapy is not known to directly cause fibroids, but therapies that contain estrogen can trigger the growth of existing fibroids. Normally, during menopause, fibroids begin to shrink and their symptoms dissipate, but women who take estrogen-only HRT may experience fibroid growth or their symptoms may become worse.
What Is The Best HRT For Fibroids?
If you have a history of fibroids, it is important for you to discuss HRT treatments with your doctor in detail. Usually, the best HRT for women with fibroids includes progesterone and not just estrogen alone. Adding progesterone can help balance out the hormones, and the combination of these two can often help the existing fibroids to grow bigger.
After menopause, existing fibroids normally begin to shrink because the body reduces the amount of estrogen it produces. When HRT is recommended for women with uterine fibroids after menopause to help manage their symptoms, they are normally not prescribed HRT that is estrogen-heavy but normally given a combination of low-dose estrogen along with progesterone. This can often help alleviate the discomfort of the menopause symptoms while managing the risk of fibroid regrowth.
Your doctor will consider your circumstances and whether you still have your uterus before determining if HRT is right for you and the hormone formulation and the method of delivery.
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FAQs
Can HRT Make Fibroid Bleeding Worse?
Yes, it can. One of the most common symptoms of fibroids is heavy or irregular menstrual bleeding, and HRT which contains estrogen can make this worse. If you are on HRT and are experiencing heavy bleeding, it is important to talk with your doctor so they can adjust your treatment or look for alternative treatments.
What Are Possible Hormone Treatments With Fibroids Side Effects?
Hormone replacement therapy can create side effects, especially for women with fibroids. Sometimes it can be due to the hormones themselves, and other times it can be the effect the hormones are having on the fibroids. Some of these side effects include:
- Fibroids getting larger
- Heavy menstrual bleeding or starting to bleed again after menopause
- Bloating or discomfort
- Mood swings
- Breast tenderness
- Headaches
If you experience pelvic pressure, worse pain, or heavier bleeding, contact your doctor for an evaluation. Tests can help reveal the source of these symptoms and determine if HRT is a contributing factor.
Do Fibroids Get Worse With HRT?
Yes. HRT may affect fibroid growth or symptoms when fibroids are present, but the response is not the same for everyone. A study of postmenopausal women found changes in fibroid volume during hormone therapy, but most only experienced small amounts of fibroid growth.
What Hormone Therapy Shrinks Fibroids?
Gonadotropin-releasing hormone (GnRH) agonists can shrink fibroids for a limited time. These medicines lower the hormone signals that drive the menstrual cycle, which can also reduce bleeding.
The effect is usually temporary, and fibroids often get larger after treatment ends. GnRH medicines send your body into an induced menopause state and cannot be used long-term. They are not the same as routine HRT for menopause symptoms.
Should You Take Progesterone If You Have Fibroids?
Not necessarily. The presence of fibroids alone does not determine whether progesterone belongs in your HRT plan. Your doctor considers whether your uterus is present and the reasons HRT is being used. They evaluate your medical history and current symptoms or bleeding patterns before determining the best treatment for you.
Should I Stop Taking HRT If I Have Fibroids?
This will depend on the specific plan you and your doctor decide on for your treatment. Your HRT does not need to stop just because you have fibroids, but If your fibroids are causing significant symptoms, your doctor may adjust your HRT plan to balance estrogen with progesterone, or they may recommend discontinuing the HRT.
Are Fibroids Due To High Estrogen?
Not necessarily. Research has not found one cause of why fibroids develop that applies to everyone, but estrogen is known to be involved in fibroid growth.
Hormone levels usually fluctuate across menstrual years, pregnancy, perimenopause, and menopause. Estrogen exposure alone does not guarantee that you will develop fibroids.
Questions to Ask Your Clinician About HRT and Fibroids
HRT may be an option for women with fibroids.
Keeping track of your symptoms and bringing a list of your current medicines can help your doctor plan a suitable treatment for you. See the chart below for some sample questions you may wish to ask to learn as much as you can about HRT during your consultation.
|
Question to ask |
Why it matters |
|---|---|
|
Which type and dose of HRT are you considering recommending, and why? |
The hormone and dose should match your menopause symptoms and medical history. |
|
Will I use a pill, gel, spray, or systemic patch? |
The route changes the way the medicine enters your body and may affect your risk level and the benefits of HRT treatment. |
|
How do estradiol and progesterone affect my plan? |
This clarifies the purpose of each hormone and whether both are being considered. |
|
What new or heavier bleeding needs an examination? |
You will know to look for changes that call for a prompt medical review. |
|
How will we monitor fibroids or related symptoms? |
A clear plan can cover symptoms, examinations, imaging, and follow-up. |
|
Who will coordinate my care? |
You will know who manages HRT and who reviews fibroid findings. |
Do not start, stop, or change HRT without the guidance of your prescribing doctor.
What Is The Best Way To Get Rid Of Fibroid Symptoms?
There is no single treatment that is right for every person with fibroid symptoms. The first step is to find the cause of the bleeding, pain, pressure, or other symptoms so a suitable treatment can be recommended. The side effects of HRT, fibroids, and other gynecological conditions can overlap, so it is often tricky to isolate the underlying cause.
A doctor may review the timing and pattern of your symptoms, perform an exam, and use imaging when needed. It should not automatically be assumed that a symptom is caused by fibroids and other possible causes should be considered.
The best treatment depends on your symptoms and how they affect your daily life. The size and location of any fibroids, medical history, and future pregnancy plans also matter. Options for treatment may include monitoring and medicines that may reduce bleeding or pain. Other treatments may use short-term hormone medicines for fibroids, a procedure, or surgery. Some medicines manage symptoms without removing fibroids.
HRT is used to manage menopause symptoms and is not a treatment that removes fibroids. A clear diagnosis helps the doctor separate the treatment for menopause symptoms from treatment for confirmed fibroids.
Treatment For Fibroids
The most effective way to eliminate the symptoms of fibroids is to get rid of the fibroids. Most women are only given surgical options (myomectomy or hysterectomy) to eliminate fibroids. Many women do not wish to undergo surgery, and the other options they are offered only treat the symptoms but do not take care of the root problem; eliminating the fibroids.
Uterine fibroid embolization (UFE) can get rid of fibroids permanently and eliminate the symptoms they cause without surgery or the side effects of GnRH treatments. This procedure does not involve surgery, and your uterus stays intact and uncompromised. The risk profile of UFE is much less than either type of fibroid surgery or other forms of treatment.
Sometimes, HRT is the best form of treatment for a woman’s condition; however, if she has fibroids, it may be beneficial to eliminate the fibroids before proceeding with HRT therapy. Working closely with a fibroid specialist can help you determine what treatment would work best for you.
Where Can I Find A Fibroid Specialist?
The Atlanta Fibroid Center is a premier fibroid treatment center located in Atlanta, GA. Women from all over the United States and other countries travel long distances to benefit from the expertise of Dr. John Lipman, a board-certified interventional radiologist and one of the world’s leading fibroids experts.
A fibroid specialist at Atlanta Fibroid Center can review bleeding, pain, pressure, or imaging findings and help separate fibroid symptoms from menopause symptoms and HRT side effects. If fibroids turn out to be the underlying cause behind new or worsening bleeding while you are using HRT, UFE may be an option for treating the fibroids.
Dr. John Lipman performs uterine fibroid embolization (UFE) in Atlanta to block blood flow to fibroids so they can shrink.
If you have fibroids and have been told you need surgery like a hysterectomy, or you have existing fibroids and are considering HRT, set up a consultation with one of these knowledgeable doctors today. During your consultation, they can review an MRI and see where the fibroids are located, how big they are, and how many there are, and provide all the information you need to make the informed decision that is best for you and your circumstances.
Book your consultation today.
