Uterine Fibroids and Menopause

Medically Reviewed by Jabeen Begum, MD on June 24, 2024
9 min read

Uterine fibroids are tumors that grow in or on your uterus, or womb. Fibroids aren’t cancerous and hardly ever turn into cancer. They're made of smooth muscle cells and other tissue that grows in or around your uterus. Up to 80% of women (and those assigned female at birth) will develop uterine fibroids by age 50.

Fibroids may appear as a single tumor or a cluster of growths. You might have one fibroid or many. They can range in size quite a bit. Some are as tiny as a seed, while others are as large as a watermelon.

Doctors haven’t figured out the exact cause of uterine fibroids. They do know that the tumors tend to grow more during the years you’re able to get pregnant. That’s because you have high amounts of the hormones estrogen and progesterone in your body at this time. These hormones are thought to play a role in the growth of fibroids. 

Fibroids usually shrink and cause fewer symptoms when your hormone levels drop as you enter menopause. But sometimes they grow even after menopause. 

There are several types of uterine fibroids. They're classified by where they're located and how they attach to your uterus.

Intramural fibroids. These are the most common type. They grow within the muscular wall of your uterus.

Submucosal fibroids. This type develops under the lining of your uterus.

Subserosal fibroids. These are found on the outer surface of your uterus. They can grow very large and expand into your pelvis.

Pedunculated fibroids. The least common type, these attach to the inside or outside of your uterus with a stalk. This makes them look something like a mushroom.

Your doctor can use imaging tests like magnetic resonance imaging (MRI) to tell which type of fibroids you have. 

 

Uterine fibroids may not cause any symptoms, especially if they're small. But you may notice:

  • Painful periods 
  • Heavy bleeding during your period
  • Bleeding between periods
  • Bloating or a feeling of fullness
  • A frequent urge to pee
  • Trouble peeing
  • Pain during sex
  • Low back pain
  • Constipation
  • Discharge from your vagina
  • A large belly that may make you look pregnant
  • A low red blood cell count, called anemia

Fibroid pain varies from person to person. You may feel heaviness, a dull ache, or cramps. In some cases, you could even have sharp, stabbing pain. This can happen when a larger fibroid gets too big for its blood supply and starts to break down.

Uterine fibroids can make it harder to get pregnant. You may also be more likely to have a miscarriage, early labor, or a C-section.

In rare cases, fibroids can cause period-like bleeding even after you're in menopause. Always see a doctor if you have any bleeding after your periods stop. You may need treatment for  fibroids, or it  could be a sign of something more serious like a thyroid problem or cancer. 

You’re more likely to get uterine fibroids if you:

  • Have obesity or carry extra weight 
  • Are in your 30s or 40s
  • Have a family history of fibroids
  • Have never been pregnant
  • Started your period before age 10
  • Started menopause later than average 
  • Have low levels of vitamin D in your body
  • Eat lots of red meat and little green veggies, fruits, and dairy products
  • Drink alcohol 

Race also plays a role in your risk for uterine fibroids. Although the reasons aren’t clear, Black people are two to three times more likely to develop them than those of other races. They also tend to get fibroids at a younger age, have larger fibroids, and feel worse symptoms. In addition, fibroids are less likely to shrink after menopause in Black people than in White people.

 

Perimenopause is the time that leads up to menopause. It usually happens when you're in your mid-40s, but it can start earlier or later than that. 

Some common symptoms of perimenopause include:

  • Irregular periods or missed periods
  • Heavier or lighter bleeding during periods
  • Mood changes, like being irritable or depressed
  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Changes in sexual desire
  • Sleep problems
  • Needing to pee more often 
  • Headaches 
  • Joint and muscle aches
  • Trouble concentrating
  • Sweating a lot

During perimenopause, estrogen levels in your body rise and drop irregularly, sort of like a roller coaster. These sudden hormone changes can trigger uterine fibroids to develop. In fact, your risk of fibroids that cause symptoms is highest during perimenopause. Research suggests that 30% of newly diagnosed fibroids happen during this time.

Uterine fibroids may make perimenopause symptoms worse. You might have heavier and longer periods, more pelvic pain, and feel the need to pee more often.

As you get closer to menopause, your estrogen levels begin to drop. Eventually, you stop producing estrogen. As this dip in estrogen causes fibroids to shrink, you may start to notice fewer symptoms.

You're in menopause when it’s been 12 months since your last period. Most people enter menopause in their late 40s or 50s. The average age is 51. After menopause, your ovaries don’t make estrogen or progesterone anymore. Symptoms of uterine fibroids usually, but not always, get better during menopause. 

Do fibroids shrink after menopause?

Uterine fibroids tend to shrink after menopause once your body stops making hormones that feed them. Smaller fibroids cause fewer symptoms. 

Do fibroids go away with menopause?

When your fibroids shrink  drastically,  your symptoms may go away completely. It might feel like the fibroids are gone. You're also  much less likely to develop new fibroids when you’re in menopause.  

Can fibroids grow after menopause?

It’s rare, but fibroids can sometime grow after menopause. This happens because other tissues in your body besides your ovaries make estrogen. For instance, the adrenal glands on your kidneys and fat cells also supply the hormone. Uterine fibroids that grow after menopause tend to cause milder symptoms. 
 

Hormone therapy is any type of treatment that changes your hormones. One type of hormone therapy is hormone replacement therapy (HRT), which treats perimenopause or menopause symptoms by replacing the estrogen your body used to make. It can't treat uterine fibroids.

HRT for menopause

Some research has found that using HRT to treat menopause symptoms could trigger fibroids to grow. But other studies suggest there’s not enough evidence to prove this. If you notice more fibroid symptoms while you’re on HRT, your doctor can lower the dose or take you off the medicine. 

Hormone therapy for fibroids

Other types of hormone therapy can treat uterine fibroids. They shrink the growths by reducing how much estrogen or progesterone your body makes or by blocking the effects of these hormones. You can get hormone therapy for fibroids as a pill, a nasal spray, an injection, an implant, or in an intrauterine device (IUD) that doctors place in your uterus.

 

 

If your uterine fibroids don’t cause any problems, you don't need treatment. Your doctor can simply monitor them, which is called “watchful waiting.” But if you're in a lot of pain or having other issues, there are several treatments that can help.

Surgery

There are a few ways to do uterine fibroid surgery, which is called myomectomy. To choose the best method, your doctor will consider the size of your fibroids, their location, and how many you have. Another important consideration is whether you plan to get pregnant in the future.

Doctors can remove fibroids with these techniques:

Hysteroscopy. Your doctor places a small, flexible tube called a scope into your uterus through your vagina. They then use the scope to cut and remove the fibroids.

Laparoscopy. With this procedure, your doctor makes a few small cuts in your belly. They place a scope through the incisions and remove the fibroids that way.

Laparotomy. Doctors make a large cut in your belly and take the fibroids out through it in this procedure.

If you don’t plan to get pregnant, you have more surgery options. These include:

Hysterectomy. This is an operation to remove your uterus. It’s the only way to get rid of fibroids for good. It may be a good choice for people with large fibroids or serious symptoms. You won’t be able to get pregnant after a hysterectomy. If doctors don't remove your ovaries during the hysterectomy, you won’t go into menopause after the surgery. 

Uterine fibroid embolization. Your doctor places a small tube in an artery that leads to your uterus. Then, they inject tiny particles that block blood flow to the fibroids to shrink them.

Radiofrequency ablation (RFA). This procedure uses microwave energy to remove fibroids. It’s typically an option for smaller growths.

Fibroids can grow back after any of these procedures except a hysterectomy. These new growths may need treatment in the future.

Medications

Some medicines that may be used to treat uterine fibroids are:

Over-the-counter pain treatments. Medications like acetaminophen, ibuprofen, and naproxen can help ease some of the pain fibroids cause.

Birth control. Some types of hormonal birth control can ease symptoms like heavy bleeding and cramps. Birth control comes as a pill, ring, injection, or intrauterine device (IUD)

Gonadotropin-releasing hormone (GnRH) agonists. This type of hormone therapy stops your body from making estrogen and progesterone. This helps shrink fibroids. But if you stop taking the drugs, your fibroids may grow back.  GnRH agonists include goserelin (Zoladex), leuprolide, and triptorelin (Trelstar, Triptodur Kit).

Gonadotropin-releasing hormone (GnRH) antagonists. These medicines can improve heavy menstrual bleeding, but they don’t shrink fibroids. They're only for people who haven’t been through menopause. Examples are elagolix (Oriahnn) and relugolix (Myfembree).

Antihormonal agents or hormone modulators. These medicines can slow or stop fibroid growth, lessen bleeding, and ease other symptoms. They include mifepristone (Mifeprex), letrozole (Femara), and ulipristal acetate (Ella). 

Tranexamic acid (Cyklokapron, Lysteda). This is a drug you take by mouth to treat heavy periods caused by uterine fibroids. You only take it on the days you have heavy bleeding.

Iron supplements. These supplements don't treat uterine fibroid symptoms but can restore levels of iron in your body if you develop anemia. 

All medicines can cause side effects. Talk to your doctor about the pros and cons before you start a new treatment. If you notice any unusual symptoms, let your doctor know. 

 

You may have seen online promotions for alternative treatments for uterine fibroids, such as diets or herbal remedies. But there’s little scientific evidence that any nontraditional methods are effective. 

Some small studies have found that acupuncture may help ease symptoms when it’s used along with standard treatments. In this treatment, a trained practitioner places tiny needles in specific points on your body. 

There’s also some evidence that vitamin D supplements can help. People who don’t get enough vitamin D are more likely to develop fibroids. Vitamin D deficiency is common in people with darker skin, which might partly explain why Black people are at higher risk for fibroids. But experts don't have enough data to recommend any particular dosage of vitamin D.

Uterine fibroids are also more common in people who have obesity or weigh more than is healthy for them. Some research suggests a diet high in red meat, fats, and sugars could increase your risk for fibroids.

 If you have uterine fibroids, these healthy lifestyle habits might help: 

  • Follow a diet that's low in processed foods and high in veggies, fruits, whole grains, and low-fat dairy.
  • Limit red meat.
  • Avoid alcohol.
  • Cut down on caffeine.
  • Try to do some moderate exercise, such as walking, every day.
  • Reduce your stress levels or practice stress-reduction techniques such as mindfulness meditation or yoga.
  • Get at least 7 hours of sleep a night.
  • Have regular pelvic exams.

Uterine fibroids are tumors that grow in or on your uterus and can cause symptoms like pain and heavy period bleeding. Fibroids are often diagnosed during perimenopause, the period that leads up to menopause, and can make perimenopause symptoms worse. Symptoms usually -- but not always -- ease once you enter menopause.