Uterine fibroids are common non-cancerous growths in the uterus, affecting up to 80% of women during their lifetime. In India, fibroids are increasingly recognised as a major cause of pelvic discomfort and heavy menstrual bleeding. Fibroids are influenced by hormones, estrogen and progesterone, which regulate their growth. During menopause, declining hormone levels often cause fibroids to shrink, though they may persist or even grow in some women due to genetic, metabolic, or weight-related factors. Early recognition and appropriate management can help women maintain comfort, confidence, and quality of life .
What Are Uterine Fibroids?
Fibroids, or leiomyomas, are non-cancerous lumps that can grow inside, within the wall, or on the outer surface of the uterus :
- Submucosal: Inside the uterine lining
- Intramural: Within the uterine muscle
- Subserosal: On the outer surface of the uterus
Causes of Fibroids
While the exact cause is unknown, key factors include:
- Hormones: Estrogen and progesterone promote growth .
- Genetics: A family history increases risk.
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Risk Factors:
- Obesity
- Early onset of menstruation
- Diet high in red meat and low in greens
- Ethnicity (South Asian and African women may be more prone). Statistics show that South Asian women often develop fibroids at a younger age and with more severe symptoms than Caucasian women .
- Delayed pregnancy or nulliparity
Symptoms of Fibroids During Menopause
Fibroid symptoms vary :
- Pelvic pressure or pain
- Heavy or prolonged periods
- Pain during intercourse
- Frequent urination
- Abdominal bloating
- Back or leg pain
Note: Around 50% of women with fibroids may have no noticeable symptoms .
Fibroids in Perimenopause and Postmenopause
- Perimenopause: Hormonal fluctuations can trigger fibroid growth; many women first notice symptoms during this stage.
- Postmenopause: Most fibroids shrink as estrogen declines. Persistent growth may require medical intervention.
Treatment Options After Menopause
1. Watchful Waiting
Small or asymptomatic fibroids can be monitored via ultrasounds.
2. Medications
- Tibolone: Mild hormone therapy for menopausal symptoms without enlarging fibroids .
- GnRH Agonists (e.g., Leuprolide): These create a temporary "medical menopause" to shrink fibroids before surgery.
3. Minimally Invasive Procedures
- Uterine Artery Embolization (UAE): Blocks blood supply to shrink fibroids (~88% success) .
- Radiofrequency Ablation (RFA): Destroys fibroid tissue using heat.
4. Surgery
- Myomectomy: Removes fibroids but preserves the uterus.
- Hysterectomy: Complete removal, usually a last resort. In India, vaginal or laparoscopic (minimally invasive) hysterectomies are now preferred over open surgery for faster recovery .
HRT and Fibroids
Hormone Replacement Therapy (HRT) can relieve menopausal symptoms but must be prescribed carefully if fibroids are present. A menopause-specialised doctor can balance relief and safety .
Lifestyle & Self-Care
- Maintain a balanced diet with greens, fruits, and whole grains
- Stay physically active (yoga, walking)
- Manage stress via meditation or mindfulness
- Ensure sufficient vitamin D through sunlight or supplements
Experiencing Fibroids During Menopause?
Take the Nuher Menopause & Fibroid Quiz to discover if HRT or other treatments may be suitable. Start your journey toward relief, confidence, and comfort. Note: HRT is a Schedule H drug. For women with fibroids, transdermal estrogen (patches/gels) is often preferred as it maintains steady levels without stimulating rapid fibroid growth.
FAQs
1. How can I tell if I have fibroids?
Symptoms include heavy bleeding, pelvic pain, or bloating. Ultrasound or MRI confirms diagnosis.
2. Do fibroids always shrink after menopause?
Most do, but obesity or genetics can keep them active.
3. Can fibroids cause postmenopausal bleeding?
Yes. While fibroids can cause it, postmenopausal bleeding is a "red flag" symptom that must be evaluated via endometrial biopsy or ultrasound to rule out malignancy.
4. Is surgery always necessary?
Not always. Many women manage fibroids with medications or minimally invasive treatments.
