Uterine fibroids are benign or noncancerous tumors or growths that develop in the muscular wall of the uterus. They develop when estrogen is present and usually shrink after menopause.

Fibroids — also called leiomyomas or myomata — can be present both before and after menopause. They are common and can appear at any age but are more likely to appear in the more advanced reproductive years as menopause approaches. It is rare for fibroids to appear after menopause.

At the age of 50, fibroids affect around 70% of white and over 80% of Black American females. The risk is significantly higher among Black American females of African origin. Black females are also more likely to have larger fibroids and to develop them from an earlier age.

Fibroids vary in size and number. Before menopause, they can affect fertility. After menopause, they tend to shrink in size due to lower estrogen levels. However, they can still be an issue, leading to pain and unusual bleeding.

Fibroids are noncancerous, but they can resemble cancerous tumors. For this reason, a doctor may remove them or take a biopsy to rule out cancer.

How do fibroids affect Black women?

A note about sex and gender

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Fibroids need the hormone estrogen to grow. After menopause, estrogen levels decrease dramatically, which usually reduces the risk of developing fibroids.

In many cases, fibroids shrink and cause fewer symptoms after menopause.

However, some people may not see a decrease in symptoms.

Hormone therapy (HT) aims to maintain levels of estrogen and progesterone during perimenopause and after menopause. For this reason, fibroids may continue to grow.

Some treatments for fibroids mean a person can no longer become pregnant. Often, this is not an issue after menopause. However, it may be a consideration for anyone who has passed menopause and is considering pregnancy through assisted reproductive technologies.

According to the Office on Women’s Health, fibroids can vary from the size of an apple seed to that of a grapefruit. A person can have one or many. For this reason, some people have no symptoms, while others can experience severe discomfort.

The symptoms of fibroids often remain the same regardless of a person’s age.

They can include:

  • heavy bleeding during the reproductive years and bleeding that can continue after menopause
  • enlarged abdomen
  • a feeling of fullness in the lower abdomen
  • pain during sex
  • pressure on the bladder or bowels
  • frequent urination
  • lower back pain

Fibroids are benign by definition, but in rare cases, a growth that appears to be a fibroid contains cancerous cells. This happens in fewer than 1 in 1,000 fibroids. Moreover, the pain and discomfort of fibroids can severely affect a person’s overall well-being and quality of life, including their ability to work or perform routine activities.

For these reasons, a person should seek medical advice if they have any symptoms of fibroids.

Treatments for fibroids can range from a “watch and wait” approach if there are no symptoms to a myomectomy if symptoms are severe.

Factors a doctor will consider when deciding on a treatment plan include:

  • size of the fibroids
  • location of the fibroids
  • a person’s age
  • the presence and severity of symptoms

Before menopause, fibroids can affect fertility. After menopause, most people do not need treatment for fibroids unless the fibroids are large or they have severe symptoms.

Here are some options a doctor may recommend.

Watch and wait

Many people choose not to have treatment for their fibroids because they tend to shrink or go away after menopause.

However, it is still important to check in with a doctor regularly to check if they have grown.

Medication

If the fibroids are causing symptoms, doctors may recommend medications.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or acetaminophen, may help relieve pain.

Gonadotropin-releasing hormone agonists (GnRHa), such as Lupron, can help shrink fibroids and make them easier to remove during surgery. A person can take GnRHa drugs by injection, nasal spray, or as an implant.

Other options include oral birth control pills or having an intrauterine device (IUD).

Surgery

Surgery may be an option if fibroids are large, or symptoms are severe.

Myomectomy

This procedure removes fibroids but leaves the healthy tissue of the uterus. New fibroids can develop after a myomectomy. Pregnancy may still be possible after this surgery.

Surgery can be open or hysteroscopic, depending on the extent of the fibroids. In a hysteroscopy, a surgeon inserts a long, thin device through the vagina and cervix into the uterus. A camera on the end of the device enables the surgeon to see the inside of the uterus. During this procedure, the surgeon can use the same tool to remove fibroids.

Hysterectomy

A hysterectomy is a procedure to remove the uterus. If surgery happens around menopause, the surgeon may also remove the ovaries.

A hysterectomy will end the symptoms of uterine fibroids, making it a suitable choice for someone with severe symptoms who is not planning to have children.

Surgeons perform a hysterectomy using open or laparoscopic surgery. They may also use a vaginal approach in a procedure known as a laparoscopic-assisted vaginal hysterectomy.

Depending on the type of surgery, recovery can take up to 6 weeks.

In the United States, fibroids are the most common reason for a hysterectomy, accounting for 37% of hysterectomies each year.

Endometrial ablation

In endometrial ablation, a surgeon removes or destroys the lining of the uterus. This can help manage symptoms.

It is possible to become pregnant after this procedure, but doctors do not advise it due to the risk of pregnancy loss and other issues. People should only undergo ablation if they are no longer planning to have children.

Myolysis

In myolysis, a doctor inserts a needle into a fibroid and passes either an electric current or freezing mechanism through the needle to destroy the fibroid tissue. It is also known as radiofrequency ablation.

Uterine fibroid or artery embolization

Uterine fibroid embolization — also called uterine artery embolization — involves blocking the blood vessels that bring blood to the fibroid. The fibroid should shrink, but pregnancy may not be advisable in the future.

People should speak with a doctor about the advantages and disadvantages of each treatment before deciding to go ahead.

Why do Black women not get the same gynecological care as others?

Fibroids are not cancerous, and most will shrink after menopause. At the same time, symptoms will likely improve.

However, fibroids may persist in those using hormone treatment. Various approaches can help resolve this, depending on whether a person still hopes to become pregnant, for example, through assisted reproductive technology.

Here are some questions people often ask about fibroids during menopause.

Should I worry about uterine fibroids after menopause?

After menopause, fibroids usually shrink, and symptoms improve. However, a person should seek medical advice if they have bothersome or ongoing symptoms or if they notice any bleeding after menopause. These may be signs of another health issue, such as cancer.

What are the symptoms of uterine fibroids after menopause?

Many people have no symptoms, and symptoms often improve after menopause, but it is still possible to experience:

  • lower abdominal pain and swelling
  • lower back pain
  • vaginal bleeding or spotting
  • frequent urination
  • a feeling of pressure in the pelvis

Can fibroids still grow after menopause?

It is rare because estrogen levels are usually very low at this stage, but it can happen. Anyone with concerns about fibroids or symptoms affecting their lower abdomen should seek medical advice. A doctor may wish to rule out other conditions, such as uterine cancer.

Uterine fibroids are noncancerous growths that commonly appear in females of reproductive age, particularly as they get older toward menopause. However, estrogen levels fall with menopause, and there is a lower risk of fibroids with symptoms.

Anyone experiencing vaginal bleeding, discomfort, or other symptoms after menopause should seek medical advice, as the symptoms of fibroids can resemble those of some severe conditions, such as cancer.