Estrogen and progesterone may increase the risk for fibroids. During menopause, these hormonal levels are lower, reducing your risk for new fibroids. But, several menopausal factors may promote fibroid development.
Uterine fibroids, also known as fibroids or leiomyomas, are small tumors that grow in the wall of a woman’s uterus. These tumors are benign, which means they aren’t cancerous. However, they can cause pain and other uncomfortable symptoms.
Fibroids are the most common types of benign tumors in women. They develop most often in women who are of childbearing age. You may continue to experience them during and after menopause — or even develop them for the first time during this stage of life.
Some risk factors can increase your chance of developing fibroids. They include:
- high blood pressure (hypertension)
- low vitamin D levels
- a family history of fibroids
- no history of pregnancy
- long-term, extreme stress
Women who are over age 40 and African American women are also at a higher risk for fibroids.
Sometimes there aren’t any symptoms of the fibroids at all. Your healthcare provider may detect fibroids during an annual pelvic exam.
Women, whether premenopausal or postmenopausal, could experience the following fibroid symptoms:
- heavy bleeding
- frequent spotting
- anemia from significant loss of blood
- menstrual-like cramping
- fullness in the lower belly
- abdominal swelling
- lower back pain
- frequent urination
- incontinence or urine leakage
- painful intercourse
A fibroid or a cluster of fibroids pushing against the uterine wall can directly cause many of these symptoms. For example, pressure from fibroids on your bladder can cause more frequent urination.
Fibroids can be difficult to address.
Birth control pills are currently the preferred drug treatment. Your healthcare provider may recommend surgical removal of your fibroids, which is a procedure known as a myomectomy. A hysterectomy, or surgical removal of your uterus, may also be considered.
Birth control pills are one possible way to manage symptoms such as pain and excess bleeding. However, they won’t shrink the fibroids or cause them to go away.
There’s evidence to support the use of both combination and progestin-only birth control pills for fibroids. Progestins can also alleviate other symptoms of menopause and make hormone replacement therapies more effective.
Other hormonal treatments that will relieve pain and bleeding include progestin injections and intrauterine devices (IUDs) that contain progestins.
Sometimes a myomectomy is performed before a hysterectomy is considered. Myomectomy targets fibroid removal and doesn’t require removal of your uterus. Myomectomies can be performed in several different ways, depending on the location of the fibroids.
If the bulk of the fibroid is inside the uterine cavity, the surgery can be performed hysteroscopically (with the aid of a thin, lighted tube).
In some instances, your healthcare provider will make an incision in your lower abdomen. The size and location of the incision is similar to an incision used for a cesarean delivery. Full recovery will take 4 to 6 weeks. This method isn’t as common as others.
Your healthcare provider may also be able to perform the surgery laparoscopically. During laparoscopic surgery, a smaller incision is made. Recovery time for laparoscopic surgery is shorter, but this type of surgery is usually only recommended for smaller fibroids.
If fibroids come back following a myomectomy, your doctor may recommend a hysterectomy.
For severe symptoms related to large, recurring fibroids, a hysterectomy may be the best option. In this type of surgery, your healthcare provider removes all or some part of your uterus.
Hysterectomies may be recommended for women who:
- are close to menopause
- are already postmenopausal
- have multiple fibroids
- have very large fibroids
- have tried many therapies, want the most definitive treatment, and have no plans for childbearing in the future
There are three types of hysterectomy:
- Total. In this surgery, your healthcare provider removes your entire uterus as well as your cervix. In some cases, they may recommend removing your fallopian tubes too. This option might be best if you have large, widespread fibroid clusters.
- Partial/subtotal. With this surgery, only your upper uterus is removed. Your healthcare provider may recommend this option if fibroids are a recurring problem in this region of your uterus. This may be confirmed through imaging tests.
- Radical. This is the most significant form of hysterectomy, and it’s rarely used in the treatment of fibroids. It’s sometimes recommended for certain gynecological cancers. With this surgery, a doctor removes your uterus, upper vagina, cervix, and parametria (surrounding tissues of the uterus and vagina).
A hysterectomy is the only way to completely cure fibroids. Each year,
Together, you and your healthcare provider can determine whether this surgery will be the best fibroid treatment for you.
Other possible treatments for menopausal or postmenopausal women include these noninvasive or minimally invasive procedures:
- myolysis, where the fibroids and their blood vessels are destroyed with heat or an electric current; one example is the procedure known as Acessa
- forced ultrasound surgery (FUS), which uses high-energy, high-frequency sound waves to destroy the fibroids
- endometrial ablation, which uses methods like heat, an electric current, hot water, or extreme cold to destroy the uterine lining
- uterine artery embolization, which cuts off blood supply to the fibroids
Fibroids are more common in premenopausal women, but you can also develop fibroids during menopause.
Talk to your healthcare provider about ways that you can manage fibroid symptoms and whether surgery is the right option for you. Fibroids that don’t cause any symptoms may not require any treatment at all.