Uterine fibroids are most common in women aged 35-49 with over 50% of females experiencing at least one fibroid in their lifetime. Fibroids typically shrink and symptoms usually subside when women reach menopause, but although rare, uterine fibroids can also grow after menopause.
This article explains why uterine fibroids can continue to grow after menopause, how hormone therapy affects their growth, what can be done to prevent them, and how uterine fibroids are treated when they’ve already developed.
What Are Uterine Fibroids?
Also known as myomas or leiomyomas, fibroids are usually benign (non-cancerous) growths of fibrous tissue and muscle that develop in or around the womb (uterus). Uterine fibroids can vary in size from a seed to a grapefruit, and multiple fibroids are also possible.
Even though they can occur earlier, fibroids are most common in the later years of the reproductive stage (age 35-49) with approximately 50% of perimenopausal women found to have at least one uterine fibroid.
Because there are no prepubescent cases of uterine fibroids and the growths tend to shrink postmenopause, uterine fibroids are considered estrogen-dependent. However, even though uterine fibroids tend to shrink due to lowered estrogen levels in menopause, they can still occur in some women.
Uterine Fibroids and Menopause
Medical research has concluded that uterine fibroids require estrogen to develop and grow, which explains why uterine fibroids are most prevalent during the reproductive years. They can also continue to develop and grow during perimenopause when estrogen levels are dropping but still present.
Once menopause is reached and estrogen production in the ovaries stops or drastically reduces, uterine fibroids usually shrink and symptoms subside. Due to this decrease in estrogen production, it is rare for uterine fibroids to develop during menopause, however, uterine fibroid development and consequent symptoms are known to persist in women taking hormone therapy (HT).
Hormone Therapy and Uterine Fibroids After Menopause
Hormone therapy is often used to supplement estrogen, progestin, or both to regulate hormone fluctuations and reduce perimenopause/menopause symptoms. These include hot flashes, insomnia, mood swings, heart palpitations, vaginal dryness, muscle and joint pain, loss of libido, and more.
Research has shown that when hormone therapy for perimenopause/menopause symptoms includes estrogen, uterine fibroids sometimes continue to grow in postmenopausal women.
Symptoms of uterine fibroids in menopause can include pelvic and abdominal pain, frequent urination, an enlarged abdomen, and abnormal uterine bleeding, despite menstruation not occurring for over 12 consecutive months.
Avoiding Uterine Fibroids Post-menopause: What Are the Alternatives to Hormone Therapy?
Most women who experience uterine fibroids during the reproductive years feel a reduction in symptoms when they reach menopause and estrogen production all but stops. However, when estrogen is re-introduced via hormone therapy uterine fibroids often continue to grow and cause painful symptoms postmenopausal. This does not occur for all women, but it can for some.
Therefore, premenopausal women who suffer from uterine fibroids and choose to take HT should be closely monitored with regular checkups and ultrasounds to ensure fibroids are not growing.
When fibroids continue to grow in women taking HT during perimenopause or menopause, they are typically recommended to relieve menopause symptoms with plant-based phytoestrogens as an alternative to HT. Instead of re-introducing estrogen, phytoestrogens mimic estrogen's effects on the body by binding to estrogen receptors and encouraging an estrogenic (or antiestrogenic) response.
In addition to relieving common menopause symptoms, maintaining bone density, and benefiting cardiovascular health, phytoestrogens also prevent the growth of uterine fibroids during and after menopause.
How to Take Phytoestrogens for Uterine Fibroids After Menopause
Phytoestrogens are naturally found in several fruits and vegetables such as apples, grapes, pears, plums, beans, cabbage, sprouts, spinach, soybeans, garlic grains, and onions. However, female health experts have concluded that a daily supplement provides a more regular and reliable dose to treat menopause symptoms and/or prevent uterine fibroids post-menopause.
Intimate Rose Vitex (Chasteberry) supplement, also beneficial for PMS symptoms, are one of the most potent, affordable, and effective phytoestrogen supplements on the market. Containing 1,000 mg of pure Vitex, with added anti-nausea ginger for digestive health, these naturally-made, vegan supplements reduce menopause symptoms and uterine fibroid growth without the risks of HT.
Bleeding in Menopause: Is it Always Uterine Fibroids?
Heavy or intermittent postmenopausal bleeding can be a sign of uterine fibroids but it's not always the case. Although estrogen therapy to treat menopause symptoms can increase the development and growth of uterine fibroids in some postmenopausal women, bleeding that resembles a period could also be a sign of something else.
Should you notice heavy or intermittent bleeding after menopause, schedule a consultation with your healthcare provider for further analysis. Even if you’ve had similar symptoms with previous uterine fibroids, it’s safer to have your symptoms checked than to assume it is fibroids.
Treating Uterine Fibroids After Menopause
Treatment options for uterine fibroids after menopause depend on the amount, location, and size of the fibroids, as well as the severity of symptoms and a patient’s overall health. In women of reproductive age, preserving fertility when treating uterine fibroids is a vital consideration. After menopause, fertility is less concerning and a wider range of uterine fibroid treatments are available.
Evaluate & Monitor
The first step in treating uterine fibroids after menopause involves evaluating and monitoring. Symptoms like uterine bleeding are not common after menopause, so healthcare providers will typically perform a pelvic exam and ultrasound to identify fibroids.
Pain medication to treat pelvic discomfort may be prescribed as further monitoring is undertaken. In some cases, an MRI could also be performed to rule out cancer or other more serious conditions.
Diet & Lifestyle
Postmenopausal patients with uterine fibroids are advised to make certain diet and lifestyle changes. Regular aerobic exercise, eating a well-balanced diet, and maintaining a healthy weight have been proven to enhance women’s overall health before, during, and after menopause. Even after menopause, managing weight gain can reduce the effects of estrogen, which can, in turn, prevent the growth of uterine fibroids.
Birth Control Pills
Birth control pills are often used to treat abnormal uterine bleeding and pelvic pain. When it comes to treating uterine fibroids after menopause, progestin-only birth control pills can sometimes relieve the bleeding and pain. However, birth control pills will not reduce the size of fibroids, meaning symptoms like abdominal enlargement and frequent urination can continue.
Phytoestrogens
If uterine fibroids are identified in postmenopausal women, switching from HT to phytoestrogen supplements, such as (Vitex) Chasteberry from Intimate Rose, can shrink uterine fibroids as well as reduce the associated symptoms. Therefore, taking daily Vitex (Chasteberry) supplements to treat uterine fibroids after menopause is considered a valid and often successful pre-emptive step to avoiding surgery.
Procedures and Surgery
If premenopausal uterine fibroids continue to grow after menopause and symptoms are severe enough to significantly lower women’s quality of life, one of the following procedures is typically performed as treatment.
These include:
- Endometrial ablation – where the uterine lining is removed or cauterized (burned)
- Endometrial Myolysis – a needle is inserted into fibroids to destroy them with an electric current or a freezing procedure
- Uterine Artery Embolization – uterine blood vessels transporting blood to the fibroid are blocked to shrink fibroids
- Myomectomy – the removal of fibroids and the uterus is left in place
- Hysterectomy – the uterus, ovaries, and offending fibroids are removed
Are Fibroids Always Non-Cancerous?
In most cases, uterine fibroids are non-cancerous, however, in rare cases (1 in 1,000) fibroids can contain cancerous cells. Therefore, it is always recommended to speak with a healthcare provider if you experience abnormal uterine bleeding or any other symptoms of fibroids.
To rule out the possibility of cancerous cells in uterine fibroids, healthcare providers typically perform an MRI or biopsy to determine the nature of the growth.
Conclusion
Although common in premenopausal women, uterine fibroids normally shrink after menopause and symptoms fade. Since uterine fibroids are estrogen-dependent, women with uterine fibroids before menopause are advised to avoid hormone therapy during menopause and take a daily dose of plant-based phytoestrogens instead.
If you are experiencing uterine bleeding after menopause, or any other symptoms of uterine fibroids, schedule a consultation with your healthcare provider for further analysis.
References
Office on Women’s Health – Uterine Fibroids - https://www.womenshealth.gov/a-z-topics/uterine-fibroids
National Library of Medicine - Uterine Fibroids in Menopause and Perimenopause - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994343/
Science Direct - Traditional herbal medicine and the decreased risk of uterine surgery among women with uterine fibroid in Taiwan - https://www.sciencedirect.com/science/article/abs/pii/S2210803323001379
National Library of Medicine - Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms - https://pubmed.ncbi.nlm.nih.gov/11368622/