Fibroids Post-Menopause: Are They a Cause for Concern?

Fibroids usually shrink after menopause, as the oestrogen that fuels their growth falls away. So a fibroid that appears to grow after menopause, or new bleeding at this stage, is worth having assessed rather than assumed to be the fibroids you already know about.

In most cases the explanation turns out to be benign, and the assessment is straightforward. Here’s why fibroids behave differently after menopause, what postmenopausal bleeding can indicate, and which changes are worth raising with your doctor.

What are fibroids?

Uterine fibroids are non-cancerous growths that develop around or within your uterus (womb). They are made of muscle and fibrous tissue and may range from very small (about the size of a pea) to several centimetres across. 

They are most commonly diagnosed during a woman's reproductive years, typically between the ages of 30 and 50. This is because, although the exact cause of fibroids is not fully understood, oestrogen and progesterone – the hormones that regulate your menstrual cycle – play a role in stimulating their growth. 

During your reproductive years, fibroids could cause symptoms such as:

• Heavy or prolonged periods

• Pelvic pressure or discomfort

• Abdominal swelling or bloating

• Frequent urination

• Constipation

• Pelvic pain

However, not all women with fibroids experience symptoms, as these growths sometimes cause no symptoms at all.

What happens to your body post-menopause?

Menopause is a natural phase that marks the time when a woman's periods permanently stop. It is confirmed after 12 consecutive months without a period, indicating the end of your reproductive years. In Singapore, most women reach menopause between the ages of 49 and 53, though this may vary from woman to woman.

The time leading up to menopause is called perimenopause, and during this phase, you may start to notice changes in your cycle and how you feel each day. Some of the changes that occur during this transition include:

• Your ovaries gradually stop producing oestrogen and progesterone

• Your ovaries stop releasing eggs

• Your menstrual cycle comes to an end

• Your periods may become irregular

• You may begin to experience symptoms such as hot flushes and sleep disruption

How do fibroids change post-menopause?

As fibroids rely on oestrogen and progesterone to develop, a natural decrease in these hormones means they are no longer stimulated to grow. Consequently, some fibroids may gradually shrink or break down over time, which could lead to a reduction in their size and an improvement in symptoms.

However, shrinkage is usually gradual and may take months to years. The speed at which this happens depends on your age at menopause, the size and location of your fibroids, and your overall hormonal health. 

As periods stop and fibroids shrink, you may notice that:

• Heavy menstrual bleeding stops once your periods have ended

• Pelvic pressure often becomes less noticeable

• Pelvic discomfort may improve, particularly if it was caused by a larger fibroid pressing on nearby organs

Is it possible for fibroids not to shrink but to continue growing?

Although oestrogen and progesterone hormone levels fall substantially after menopause, shrinkage is not always guaranteed. Some fibroids persist or remain large, and, in rare cases, existing fibroids may continue to grow after the menopause.

This is more likely if:

• Your fibroids were very large or numerous before menopause

• You are overweight, since fat tissue may continue to produce oestrogen after menopause

• Certain genetic factors make your fibroids less responsive to hormonal changes

Although new fibroids rarely form after menopause, if an existing fibroid continues to grow, it is a good idea to consult a gynaecologist. Request an appointment with Thomson Medical.

What symptoms could fibroids cause after menopause?

Many postmenopausal fibroids cause no symptoms at all. For many women, this stage of life brings relief from the discomfort they had before. 

However, some fibroids, particularly larger ones, may still cause discomfort. You might notice:

• A feeling of pelvic pressure or heaviness

• Needing to urinate more often if a fibroid is pressing on your bladder

• Constipation if a fibroid is pressing on your rectum

• Occasional pain if a fibroid starts to break down on its own

One symptom that always needs prompt attention is any bleeding after menopause. While fibroids may occasionally be a factor, any bleeding after your periods have ended needs to be assessed by your doctor to rule out other causes such as endometrial cancer.

How are fibroids diagnosed after menopause?

If your doctor suspects you have fibroids, or if they want to monitor existing ones, they will usually start by carrying out an assessment and arranging further tests if necessary. They may recommend one or more of the following:

• A pelvic exam to check whether your uterus feels enlarged

• An ultrasound scan to confirm the size and location of any fibroids

• An MRI scan for a more detailed picture, particularly if fibroids are large or the picture is more complex

• An endometrial assessment if you have experienced any bleeding, which looks at the lining of the womb to rule out other causes

After menopause, the diagnostic process is similar, but the clinical focus shifts. Your doctor will check the size of your fibroids and also consider whether they are the likely cause of the symptoms mentioned above, since other conditions become more common at this stage.

What are the treatment options for fibroids after menopause?

Many women need no treatment after menopause, but the right approach will depend on your symptoms, the size of your fibroids, and your overall health. If treatment is needed, your doctor will talk through the options best suited to you.

Observation

If your fibroids are shrinking and not causing symptoms, regular monitoring is often the most suitable approach. Your doctor may arrange scans from time to time to track any changes and step in only if needed.

Medications

Hormone replacement therapy (HRT) is a treatment that helps manage menopausal symptoms by supplementing oestrogen and progesterone. 

If you are taking HRT and your fibroids appear to be responding to it, your doctor may suggest adjusting your prescription. This could mean changing the type of HRT, lowering the dose, or exploring other options more suitable for your situation.

Minimally invasive procedures

For women with persistent symptoms who would prefer to avoid surgery, uterine artery embolisation (UAE) may be an option. This procedure blocks the blood supply to the fibroid, which causes it to shrink.

Surgical options

Surgery is considered when fibroids are large, persistent, or significantly affecting your daily life.

Depending on your situation, your doctor may discuss:

• Myomectomy:

  • Myomectomy removes the fibroid while keeping your uterus in place. This is rarely recommended after menopause but may be suitable in certain situations.

• Hysterectomy:

  • Hysterectomy removes the uterus entirely and may offer lasting relief for women with persistent fibroid symptoms after menopause.

The choice between these options depends on the severity of your symptoms, the size and location of your fibroids, your overall health, and your personal preferences. As surgery after menopause comes with its own considerations, your doctor will assess these carefully before making a recommendation.

Postmenopausal fibroids may not always require treatment, but symptoms should still be assessed. Request an appointment with Thomson Medical for a diagnosis and advice on your management options.

FAQ

Should I be concerned about fibroids after menopause?

Can fibroids grow during menopause?

Can certain foods or lifestyle changes reduce fibroid risk after menopause?

What is fibroid degeneration, and is it something to worry about?

Fibroid degeneration is a natural process where a fibroid breaks down on its own after menopause. In most cases, it is simply a sign that the fibroid is shrinking, which is a normal process after menopause.

Is a hysterectomy at 60 different from one at 40?

Does a family history of fibroids mean I am more likely to develop them after menopause?

Having a family history of fibroids does increase your overall likelihood of fibroid development. However, after menopause, the risk of new fibroids forming is very low regardless of family history, as oestrogen and progesterone levels fall.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice based on your unique conditions, request a consultation with Thomson Medical.

References

Ang, S. B., How, C. H. (2013). Menopause: An important milestone in women’s health. Singapore Medical Journal, 54(2), 60-63. https://doi.org/10.11622/smedj.2013025