Fibroids After Menopause: Hormonal Changes and Symptoms

What Are Fibroids and How Do They Form?

Fibroids (also called leiomyomas or myomas) are benign (non-cancerous) growths that form within or on the wall of your uterus. These are the most common types of non-cancerous growth in women. Fibroids can be as tiny as a mustard seed or as large as a melon. A woman may have just a single fibroid or even more than one.

There are different types of fibroids based on their location:

1. Intramural Fibroids:

• These are the most common type of fibroids and grow within the muscular walls of the uterus.

2. Subserosal Fibroids:

• These fibroids grow on the outer wall of the uterus and bulge into the pelvis. These fibroids can become very large in size.

3. Submucosal Fibroids:

• These are the least common types of fibroids and are found just beneath the innermost lining of the uterus (endometrium). These fibroids bulge into the uterine cavity.

4. Pedunculated Fibroids:

• This type of fibroid is found inside or outside the uterus and is attached to the uterine wall by a stalk, similar to how an apple hangs from a tree.

Did you know? 

Oestrogen can make fibroids grow or shrink!

Fibroids are oestrogen-sensitive tumors. As mentioned earlier, not the dangerous tumors! Oestrogen-sensitive tumor means that the growth or shrinkage of fibroids is directly influenced by the hormone oestrogen. 

During your reproductive years, the high oestrogen levels stimulate fibroids to grow. After menopause, when the oestrogen levels fall, fibroids tend to grow smaller or shrink in size.

Why Do Fibroids Persist or Develop After Menopause?

Normally, the rapid fall in oestrogen post-menopause causes the fibroids to shrink and stop growing. But why is it that in some women, the fibroids don’t go away after menopause? Here’s what causes fibroids to persist or grow after menopause:

1. Ovarian and Adrenal Hormones:

• In some women, even after menopause, the ovaries continue to produce oestrogen. Adrenal glands, located on the top of each kidney, produce androgens, which are converted into oestrogen by biochemical processes within the body. This oestrogen stimulates fibroids to grow.

2. Hormone Replacement Therapy (HRT):

• HRT is a treatment to replace low hormone levels that happen naturally during menopause. When women take oestrogen therapy for menopausal symptoms, it can stimulate the growth of fibroids.

3. Obesity and Fibroid Growth:

• “Adipose tissue, a major site for storage and metabolism of sex steroids, is the primary source of oestrogens.” - PubMed.
• Fat cells in your body produce oestrogen. In an obese person, the oestrogen levels will be higher, even after menopause, which can encourage the growth of fibroids.

Symptoms of Fibroids After Menopause

A small fibroid might not cause any discomfort at all and might even go unnoticed. However, if the fibroids are bigger or multiple, it can lead to significant discomfort. Symptoms of fibroids are:

• Heavy vaginal bleeding or vaginal spotting post-menopause.
• Pelvic pain and discomfort.
• A feeling of pressure or fullness in the lower abdomen.
• Pain during sex (dyspareunia).
• Tendency to urinate frequently due to fibroids pushing against the bladder.
• Difficulty emptying your bladder completely.
• Constipation or difficulty in passing stools if the fibroids press against the rectum.
• Swollen abdomen due to the large size of fibroids.
• Low back pain or pain radiating down the legs if the fibroids press against nerves.

How to Diagnose Fibroids After Menopause

Diagnosis of fibroids involves taking a thorough medical history, a pelvic examination and the use of imaging techniques. Diagnosing fibroids is important to distinguish them from other potential and dangerous conditions that cause masses in the pelvis and vaginal bleeding after menopause. 

1. Pelvic Ultrasound:

• This is a commonly used non-invasive diagnostic tool. It provides a clear image of the size, location and number of fibroids you have.

2. Magnetic Resonance Imaging (MRI):

• This is also a non-invasive imaging technique and is usually done in complex cases. It gives high-resolution images of the fibroids to understand their size, number and location and distinguish them from other abnormalities.

3. Hysteroscopy:

• This is a minimally invasive diagnostic tool, where the doctor inserts a flexible tube called a hysteroscope through the cervix into the uterus. Hysteroscopy allows your doctor to directly visualise the insides of your uterus, diagnose fibroids, and determine if it is causing any obstruction within the uterus.

4. Biopsy:

• A biopsy is a procedure where a tiny piece of tissue is removed from your body and studied under a microscope. A biopsy is rarely done for fibroids, but if there is a chance for malignancy, your doctor may advise this test to rule out cancer.

Treatment for Uterine Fibroids After Menopause

Though the statement that uterine fibroids regress with the onset of menopause is true, it does not happen in everyone. Treatment for fibroids becomes necessary when they become symptomatic and cause pain or discomfort. Let us explore the common treatment options available for treating uterine fibroids.

1. Observation and Monitoring

Usually, fibroids do not cause any discomfort or symptoms. In such cases, immediate treatments are not required. However, regular monitoring should be done through ultrasounds and other imaging techniques to catch any changes at the earliest.

2. Hormonal Therapy

Hormone therapy for treating fibroids aims to relieve the symptoms rather than remove the fibroids themselves. Hormonal therapies for fibroids include:

a) Progestin Therapy:

• Progestin therapy is used to control heavy bleeding due to fibroids. Progestin (a synthetic form of progesterone) makes the inner lining of your uterus thin and thus reduces bleeding.

b) Low Dose HRT (Hormone Replacement Therapy):

• Combined HRT, i.e., a combination of oestrogen and progesterone, is used to treat fibroids but in very low doses. This can help relieve menopausal symptoms and also reduce bleeding caused by fibroids.

c) GnRH Agonists and Antagonists:

• These medications act by suppressing the hormone production from the ovaries, causing the fibroids to shrink and also reducing symptoms like heavy bleeding. However, they can cause side effects like hot flashes and loss of bone density.

3. Other Effective Treatments

a) Uterine Artery Embolization (UAE):

• This is a minimally invasive procedure done under local anaesthesia, which involves cutting off the blood supply to the fibroid, causing it to shrink gradually.

b) MRI-Guided Focused Ultrasound Surgery (FUS):

• This is a non-invasive procedure that makes use of high-frequency sound waves (ultrasound) to destroy fibroid tissue. This is beneficial for those who want to avoid surgery.

c) Endometrial Ablation:

• This is a minimally invasive procedure done when fibroids cause bleeding. Here, a hysteroscope is inserted into the uterine cavity to destroy the innermost lining or endometrium, either by using heat, laser, or electric current or by freezing it.

d) Myomectomy:

• Here, the fibroids are removed surgically through an incision made on the lower abdomen. For submucosal fibroids that project into the uterine cavity, this procedure can be done without an abdominal incision by using a hysteroscope (a tube inserted through the cervix into the uterine cavity).

e) Hysterectomy:

• In severe conditions like heavy bleeding, or if the fibroids are large and many in number, then a hysterectomy or the complete removal of the uterus along with the fibroids may become necessary.

Lifestyle Changes and Natural Remedies

Simple changes in your diet and lifestyle, along with natural remedies, can help reduce symptoms associated with fibroids. Here are some effective methods which you can practise from the comfort of your home.

• Eat a balanced diet that includes fruits and vegetables, whole grains and lean meat (meat low in fat content like chicken, turkey and fish).
• Include omega-3 fatty-acid-rich fish (sardines, mackerel) and nuts (walnuts, hazelnuts, almonds).
• Your diet should also contain green-leafy vegetables and berries, which are a good source of antioxidants.
• Maintain a healthy body weight by exercising regularly to prevent oestrogen levels from increasing.
• Practise stress management techniques like mindfulness, Yoga, and meditation, and engage in your favourite hobbies.
• Stay hydrated by drinking plenty of water.
• Sleep well for at least 7 to 9 hours every night. A good sleep balances hormone levels and relieves stress.
• Limit alcohol and caffeine as it can influence the levels of oestrogen.
• Herbal supplements like chasteberry, turmeric, green tea extract, Indian ginseng, and dandelion root may help manage the symptoms related to uterine fibroids. Make sure to consult a healthcare provider to know the right herbs and their dosages for you.

When to Seek Medical Attention

In most women, the decreasing levels of oestrogen after menopause cause the fibroids to shrink. However, this is not the case with everyone. If you notice these symptoms, get medical care immediately:

• Abnormal bleeding or spotting after menopause.
• Severe pelvic pain or discomfort.
• Sudden enlargement of the abdomen.
• Bowel and bladder issues like constipation, frequent urination, or pressure in the rectal area.
• Signs of infection like fever, chills and unusual vaginal discharge.
• Sudden, unintentional weight loss.

These symptoms might indicate fibroids or other serious underlying conditions. A proper diagnosis and appropriate medical intervention can help relieve the symptoms, support your overall health and sexual well-being, and improve your quality of life.

Wrapping It Up

Fibroids are very common and develop in the uterus during your reproductive years. These fibroids shrink naturally after menopause, making it less common during this phase of your life. However, in some women, fibroids may still persist, or new fibroids develop post-menopause due to hormonal imbalances. 

If you notice symptoms like bleeding, pelvic pain, or bloating, seek medical care. The wide variety of treatment options available today can help treat fibroids after menopause effectively and improve the quality of your life.

Conventional treatments include conservative methods like medication, lifestyle modifications, and herbal remedies. In more severe cases, surgical intervention might become necessary.

Don’t stress – Fibroids are benign growths that can be effectively treated with the right and timely approach. 

Connect with experienced Ayurvedic practitioners at Nirva for more support in understanding fibroids and to learn natural ways to manage them.