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You're more likely to develop uterine fibroids as you approach the menopause — what do you need to know about the symptoms, risk factors, and treatment?

Uterine fibroids — also known as leiomyomas or myomas — are so common that nearly half of all women will have them at some point in their lives. These tumors, which can be tiny, huge, and anything in between, are almost always benign (non-cancerous) but that doesn't make them harmless as fibroids can have a huge negative impact on your quality of life in some cases.

What do you need to know about fibroids if you're currently approaching the menopause?

Fibroids: Risk factors

If you're currently going through the perimenopause, you're more likely to develop uterine fibroids than ever before — before your lifetime exposure to the female hormone estrogen is greatest at this time.

You're more likely to develop uterine fibroids if you:

  • Eat lots of red meat
  • Are obese
  • Are African American
  • Have experienced extreme stress
  • Have a family history of fibroids
  • Suffer from hypertension
  • Are vitamin D deficient
  • Haven't been pregnant

Uterine fibroids: Are there any signs?

Sometimes. Uterine fibroids are often asymptomatic, meaning you won't have a clue you have them unless your OBGYN finds out during a routine checkup. They can, however, also cause symptoms. Some things to watch out for are:

  • A bloated, swollen belly
  • Pain or pressure within the pelvis, bladder (this can cause frequent urination), or bowels
  • In women who still have periods — heavy or prolonged menstrual bleeding, bleeding between periods, and anemia
  • Fatigue
  • Pain during sex
  • Pain in the back of your legs
  • Lower back aches
  • The fibroids can be felt by your healthcare provider

How are uterine fibroids treated?

It varies. If you're not experiencing any symptoms, you and your doctor may choose expectant management — doing nothing but keeping an eye on the situation. At the extreme end, women with severe, life-altering, symptoms may be advised to have a hysterectomy.  

The best treatment plan for your fibroids depends on:

  • How big the fibroids are
  • Where they are located
  • How old you are
  • How bad your symptoms are

Uterine fibroids: Expectant management

Menopausal women don't typically require treatment for fibroids, as they will no longer interfere with fertility and are unlikely to pose a danger. Unless your fibroids are making your life hell, a watch-and-wait approach is perfectly acceptable, in part because fibroids often shrink or disappear entirely on their own after you have hit the menopause. Check in with your doctor regularly to see if there are any changes, though.

Pharmacological approaches to treating fibroids

Symptomatic fibroids can be managed with:

  • Painkillers like NSAIDs.
  • Iron supplements, if you suffer from heavy and long periods because of your fibroids (some perimenopausal women will)
  • Birth control pills, especially progestin-only ones, can also manage heavy menstrual bleedng.
  • Gonadotropin-releasing hormone agonists (GnRHa) like Lupron can be prescribed to shrink uterine fibroids. Because it places you at a higher risk of osteoporosis, it isn't ideal for menopausal women.

Surgical options to manage fibroids

Fibroids that cause extreme symptoms, or very large fibroids, can be managed surgically. A few different operations come into play:

  • Endometrial ablation is a procedure that destroys the endometrium, the uterine lining, and fibroids with it. It makes pregnancy extremely dangerous, but if you're menopausal, it is among the first choices.
  • Myolysis destroys fibroids with freezing or electric currents.
  • Hysterectomy, sometimes coupled with oophorectomy (the removal of the ovaries) might seem like an invasive step, but it is an option for women who have already entered the menopause as well as for those of reproductive age who do not want to become pregnant. 
  • A uterine artery embolization blocks the vessels supply your fibroids, making it shrink. This option is not suitable for women who want to get pregnant at any point. 
  • Myomectomy is the surgical removal of fibroids, typically recommended for women who would like to become pregnant, and not usually advised to women who have entered the menopause or are about to.

What will menopause do to your uterine fibroids?

If you're currently in the perimenopause, it is very likely that your fibroids will either shrink or disappear after the menopause, and that you'll be free of any symptoms you are currently suffering from. Hormone replacement therapy supplies the hormones on which the fibroids thrive, however, so women using HRT may continue to notice symptoms and require treatment. 

Note that women who have entered the menopause but who experience vaginal bleeding and any other fibroid-related symptoms should seek medical attention — these symptoms can also indicate cancer in some cases, so that is something that needs to be ruled out.

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