Your body goes through several changes in menopause because the ovaries stop making estrogens and progesterones, and your menses come to an end. These hormones are responsible for several symptoms like night sweats, hot flashes, vaginal dryness, sleep problems, etc. They will even have an impact on fibroids, which we will see in the sections to come.
Fibroids are uterine tumors that are made of connective tissues and muscle cells. As per estimations, 70-80% of women are likely to have fibroids at least once in their lifetime. In some women, the symptoms would be mild, while in some, it would be intense. However, some may not show any signs and need no treatment. Most fibroids are benign, but some start as cancer. However, there isn’t any possibility of benign fibroids transforming into cancer in the long run.
So, if you’ve lived with fibroids all your life, you must be wondering what will happen to them when you enter the menopause transition and menopause phase. Or, if you have never had fibroids, you could be anxious about whether you will develop them in menopause.
Fibroids and Menopause – The Connection
So, coming to the topic, before getting at how the fibroids appear after menopause, it is essential to establish the connection. Read on to know more:
How Are Fibroids Related to the Hormones?
Fibroids are associated with the two significant reproductive hormones – estrogen and progesterone. These hormones encourage the development of fibroids.
Therefore, in the premenopausal stage, i.e., your active reproductive years, you are at a greater risk of being affected with fibroids. In the perimenopause phase, the estrogen and progesterone levels fluctuate and show a declining trend. In the menopause stage, these hormone levels fall drastically. So, the risk of fibroids is comparatively lessened, not eliminated.
What Happens to the Fibroid in the Perimenopause and Menopause Phase?
Suppose you had fibroids during your reproductive year. In that case, chances are that as you near menopause or have already hit the menopause phase, these fibroids shrink or reduce in size. Many women have even mentioned the associated symptoms to have been eliminated. In menopause, you are also less susceptible to developing new fibroids.
However, that doesn’t mean if you’ve been diagnosed with fibroids and are nearing the 40s, you’ll wait for them to go away on their own as you advance into the perimenopause stage. If untreated, fibroids could give you uncomfortable and disturbing symptoms. True that they will lessen in size and severity when your periods stop. But it cannot be guaranteed that menopause will always send your fibroids away. Exceptions exist; some women might still keep experiencing fibroid symptoms like they did in their child-bearing years.
Who is at Risk of Developing Fibroids After Menopause?
As mentioned, fibroids after menopause are pretty uncommon but not impossible. If you had existing fibroids, they could even continue up to menopause without any changes in the symptoms and severity.
You could even develop new fibroids in menopause, even if the chances are rare. Women could be at risk of fibroids if:
- They have a history of high blood pressure
- Are deficient in Vitamin D
- Have a history of obesity
- There has been a history of fibroids in their family
- There isn’t any pregnancy history;
Ethnicity also plays a significant role here. It has been seen through ultrasound evidence that Black Americans of Afro origin are at a greater risk of developing fibroids than white women by age 50. While 70% of white women are susceptible to fibroids, the percentage of Afro-Americans affected is 80% and above. Studies have even shown that Afro-American women have experienced severities of symptoms than their white counterparts.
What Are the Symptoms of Fibroids After Menopause?
The symptoms of fibroids after menopause are no different from what you may experience during your childbearing years.
- Enlarged or distended abdomen
- Abdominal (lower) fullness
- Abdominal pain or cramping
- Frequent and increased urination
- Pain during intercourse
- Low back pain
- A problem in emptying the bladder completely
- Urinary incontinence
Fibroids also have an impact on menstrual bleeding. Women who experience fibroids in the premenopausal stage, i.e., the time before they transition into menopause, will go through inconsistencies in their menstrual cycle. They may go through heavy bleeding, and the period may last longer than seven days. In menopause, women will not experience period-related problems. However, the bleeding will continue even after entering the postmenopause stage.
Treatment Procedure for Fibroids
The treatment depends on the severity of the fibroids. Some women might not show signs and may only know they have fibroids once their healthcare provider conducts their annual pelvic test.
In such cases, the doctor may prefer to wait a while and assess the symptoms rather than start the treatment. In severe cases, medicines and surgical procedures are needed to shrink or eliminate the fibroids.
The doctor plans the treatment according to the following parameters:
- The fibroid’s size
- Its location
- The age of the person
- The severity and intensity of the symptoms
Let us check out the several treatment methods prescribed by the doctor. They are as follows:
1. Hormone Therapies
Many healthcare providers prescribe birth control pills for managing some of the symptoms related to fibroids, like excessive bleeding and increased pain. However, there isn’t any evidence to show the effectiveness of birth control pills in lessening the size of fibroids.
Gonadotrophins are hormones that help regulate the testes and ovary functions. GnRHa (Gonadotropin-releasing hormone agonists) medications like Lupron significantly lower the size of fibroids by reducing estrogen levels. GnRHa medications may be taken as sprays, injections, or implants.
Medical practitioners may even prescribe anti-inflammatory medications like acetaminophen and ibuprofen for relieving symptoms of pain caused due to fibroids.
2. Surgical Treatments
If the fibroids are of an increased size, surgery might be needed to remove them. Here are some of the standard surgical procedures that doctors mainly prescribe.
- Myomectomy – In myomectomy, the target is to remove the fibroid only. The healthy uterine tissues are predominantly left intact. Since only the fibroid is removed through this surgical procedure, but the uterus is left untouched, there are chances of new fibroids developing.
If you’ve had a myomectomy surgery, you can still get pregnant. There are several ways of performing myomectomy depending on the fibroid’s location. If the fibroid majorly lies within the uterine cavity, a hysteroscopy is performed. No incision is made. Instead, the surgeon performs the procedure through a long, telescope-like device inserted in the uterus via the cervix and vagina.
In another method, the incision may be done in the lower abdomen, similar to the one done during a C-section. The recovery time is 4-6 weeks.
Another option is laparoscopic surgery, which is preferable when the fibroid’s size is small. If the fibroid recurs after myomectomy, the next step would be a hysterectomy, as suggested by many doctors.
- Hysterectomy – A hysterectomy is needed when the symptoms are severe, or the fibroids are big or recurring. In this type of surgery, either part of the uterus is removed, or sometimes, in cases of severity, the entire uterus may be removed. This isn’t apt for someone who wants to get pregnant.
A hysterectomy is apt for women who are:
- Those who are nearing menopause
- Are in the postmenopause phase
- Have multiple and/or large fibroids
- Have no family planning in the future
Hysterectomy is of three kinds – total, partial/subtotal, and radical. In total hysterectomy, the whole uterus and cervix are removed. Sometimes, the fallopian tube is removed as well. When the fibroids are large or widespread, this procedure seems apt.
In the partial or subtotal procedure, the upper uterus is removed. If the problem recurs in that part of the uterus, the doctor may only advise a partial hysterectomy. In the partial or subtotal procedure, the upper uterus is removed. If the problem recurs in that part of the uterus, the doctor may only advise a partial hysterectomy.
Radical hysterectomy isn’t that common for fibroids and is mainly used to treat some gynecological cancers. It involves the removal of the uterus, vagina and cervix.
The best way to cure fibroids entirely is a hysterectomy. In the United States, over 3,00,000 women undergo the same to get permanent relief from fibroids. The surgery takes a recovery time of approximately six weeks.
3. Other Treatments
Besides the surgical treatments mentioned above, there are some minimally invasive or non-invasive procedures to remove fibroids. Let us take a look at them:
Heat or electric current destroys the fibroids and the associated blood vessels in this procedure. It is used for shrinking smaller fibroids but isn’t a permanent solution. It isn’t recommended for women wishing to get pregnant. This procedure results in severe pregnancy complications like infection and uterine scarring.
- Endometrial ablation
This method aims to destroy the uterine lining through procedures like freezing, heated balloons, radio frequency, microwave, etc. This procedure comes with certain complications, and women desiring pregnancy in the future are advised not to go for it.
- Forced ultrasound surgery
Forced ultrasound surgery is a non-invasive method for destroying fibroid tissues using high-frequency sound waves.
- Uterine artery embolization
This is a procedure where the surgery is done in a way so that the blood flow to the fibroids is blocked. This makes the fibroids shrink and helps lessen or relieve the symptoms.
As mentioned, fibroids are mostly benign, but at times, though rare, they may be cancerous. It is essential to know that fibroids aren’t cancerous. Instead, the cancerous cells could grow within the fibroid, making it malignant. Several signs notify the fibroids have become cancerous. These include:
Acute pain in the pelvic or abdominal region because of quick growth of fibroids
Increased bleeding in the post-menopause phase
Anemia and fatigue (due to heavy bleeding)
Abnormal findings in blood and imaging tests
Menopause is most likely to lessen the severity of fibroids, but it isn’t a complete cure for them. So, when you feel the symptoms, it is always better to treat them lest it could aggravate and get uncomfortable.
Fibroids aren’t life-threatening; most women have mild symptoms, while some have none. However, when the symptoms are severe, it could get troublesome. Discussing an apt treatment plan with your healthcare provider is always important.
As mentioned already, fibroids get better with menopause, and the symptoms improve also. But, some women may continue to experience symptoms like before. If you are in pain or have intense bleeding in postmenopause, you must get yourself checked immediately.
Fibroids and their symptoms mostly subside by the time you reach menopause. But that doesn’t mean you will take your fibroids for granted in the premenstrual years and wait for menopause to set in. If you are troubled with fibroid in your child-bearing years, you shouldn’t ignore it. Rather, seeking a doctor’s consultation is of utmost importance.