Fibroids are tumors or growths that develop in the muscles of the uterus. They are also called leiomyomas or myomas.
According to the UCSF Medical Center, these growths are very common and can affect up to 50 percent of women at some point in their life.
Fibroids affect mostly women in their 30s and 40s and tend to affect African-American women more frequently.
These growths are almost always noncancerous. A woman may have just one or more fibroids at one time, and they can range in size from very small to very large.
In many cases, fibroids actually shrink and cause fewer symptoms for women who have reached menopause.
Women who are taking hormone replacement therapy (HRT) during perimenopause or after menopause may not see a decrease in their symptoms. This is because HRT usually contains a combination of estrogen and progesterone, which are the same hormones that allow fibroids to grow in younger women.
The symptoms of fibroids remain the same regardless of a woman's age when they occur. Symptoms include:
- enlarged abdomen
- pain during sex
- pain in the back of the legs
- pelvic pain or pressure
- pressure on the bladder or bowels
- low back pain
Some women do not experience symptoms and may not even know that they have fibroids unless a gynecologist finds them during a routine visit.
Other women have very severe symptoms, which may leave them unable to go to work or carry out routine activities.
Treatments for fibroids range from a "watch and wait" approach for women who do not have symptoms to complete removal of the uterus (hysterectomy) in women with severe symptoms.
The doctor will consider many factors when deciding on a treatment plan. Some of these factors include:
- size of the fibroids
- location of the fibroids
- a woman's age
- the symptoms that she is experiencing
Unless she is experiencing symptoms, a woman does not usually need treatment for fibroids after menopause unless they are very large.
"Watch and wait"
Many women choose to not have treatment for their fibroids because of their tendency to shrink or go away after menopause. However, it is still important to check in with the doctor regularly to see if they have grown.
If the fibroids are causing symptoms, doctors may recommend medications. These include:
- Pain medicine: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or acetaminophen, can help relieve some of the symptoms and pain associated with fibroids.
- Iron supplements: Women with heavy menstrual bleeding may benefit from taking an iron supplement, especially when they have their period. Iron can help prevent anemia caused by excess blood loss.
- Birth control pills: Low-dose birth control pills and some progesterone-only contraceptives can help to control heavy bleeding.
- Gonadotropin-releasing hormone agonists (GnRHa): The most common drug in this class is called Lupron. These GnRHa drugs can help shrink fibroids and make them easier to remove if surgery is possible. However, Lupron may cause severe side effects and is linked to bone loss, so most doctors will only prescribe it for less than 6 months.
For women with large fibroids or who are severely affected by their symptoms, surgery may be an option.
A hysterectomy is a surgery that involves the removal of a woman's uterus. If the woman is in menopause or close to menopause, surgeons may also remove her ovaries.
A hysterectomy will definitively end the symptoms of uterine fibroids, which makes it a good choice for a woman with severe symptoms and who does not want or has already had children.
Surgeons perform a hysterectomy through an incision in the abdomen or through the vagina.
Endometrial ablation is a procedure where the lining of the uterus is either removed or destroyed to control a woman's symptoms.
A woman will be unable to get pregnant after this procedure, so it is not a good choice for women who are considering pregnancy in the future. For postmenopausal women, this will not be an issue.
Myolysis is a procedure where a doctor inserts a needle into the fibroid. Either an electric current or a freezing mechanism is passed through the needle to destroy the fibroid tissue.
Uterine artery embolization (UAE)
Women who have severe symptoms and do not want to have a hysterectomy may be a good candidate for UAE. This procedure involves blocking the blood vessels that bring blood to the fibroid.
This procedure causes the fibroid to shrink, but it also prevents a woman from becoming pregnant in the future.
A myomectomy is an operation that involves removing the fibroids while keeping the uterus. A myomectomy is the best option for a woman who wants to have children in the future. Doctors are not likely to recommend it for women who are already in menopause.
In an abdominal myomectomy, a surgeon makes a larger incision in the lower abdomen, removes the fibroids and closes the wound.
In a laparoscopic myomectomy, a surgeon makes four small incisions and inserts medical instruments into these holes to remove the fibroids.
In most cases, fibroids will shrink to a much smaller size and no longer cause any symptoms after menopause.
Women who take HRT or who still have higher levels of estrogen may not experience a decrease in the size of their fibroids. These can be treated using a variety of methods that will depend on the size of the fibroids and the severity of woman's symptoms
It is important for a woman who is having vaginal bleeding or other symptoms of fibroids after menopause to see her doctor. Vaginal bleeding after menopause needs to be evaluated to make sure that there is not a more serious cause.