Uterine fibroids and menopause

While menopausal women not using HRT can expect a probability that their uterine fibroids would shrink and even disappear, the probability of this happening in women using HRT reduces. Read on to know more

By Dr Vasundhra Atre

20 to 80% of women by the age of 50 are affected by fibroids, the benign tumours that occur within the female uterus. Fibroids cause painful symptoms in some women while other women suffer little if any effects. There are many women who have fibroids without even knowing.


The exact cause of uterine fibroids remains unclear. Genetics may play a key role. A strong association between the levels of female hormones and fibroids has been made. The possibility of an excess of the female hormone oestrogen as a key factor in causing fibroids has been studied. Oestrogen tends to encourage the growth of fibroids, as the oestrogen production decreases, so do the chances of uterine fibroids occurring in postmenopausal women. Based on this concept new treatment protocols for patients with uterine fibroids are under investigation.

The fibroids first tend to make their appearance most commonly in women between the ages of 30 and the onset of menopause. They occur less commonly in women in their 20s and in older women. Typically, the uterine fibroids gradually increase in size from the first occurrence on through menopause and thereafter in many but not all instances shrink in post-menopausal women.

Fibroids post menopause

It has been observed that in some menopausal women uterine fibroids tend to shrink and may even ultimately disappear. However, post-menopausal fibroids do occur. The possible cause of the fibroids, the typical life cycle of fibroids, the results of hormone-replacement therapy (HRT), the role of progesterone in menopausal and post-menopausal women with fibroids are factors that can help predict the likelihood of post-menopausal shrinkage or disappearance of uterine fibroids.

Generally in women with existing uterine fibroids entering menopausal years, the fibroids will shrink and often disappear over time. In menopausal and post-menopausal women on conventional HRT (Hormone Replacement Therapy) the oestrogen dominance continues maintaining the conditions under which uterine fibroids thrive. Hence, while menopausal and post-menopausal women not using HRT can expect a probability that their uterine fibroids would shrink and even disappear, the probability of this happening in menopausal and post-menopausal women using HRT reduces.

The oestrogen and fibroid link

Oestrogen dominance as a factor in the existence and as a probable root cause of uterine fibroids is gaining acceptance. Alternative treatments to counteract the fibroid-related effects of conventional HRT are being explored. Use of natural progesterone to alleviate the fibroid-related effects of traditional treatments by helping to create the environment that is likely to promote shrinkage of the fibroids is being studied; the initial results have seem promising.

Though rare, development of uterine fibroids in post-menopausal women with no pre-existing fibroids does occur. Hormonal ratios, rather than the volume of oestrogen itself, are said to play a role. Environmental influences such as pesticide and auto-exhaust fumes have also been implicated in the disruption of normal hormonal balances leading to the development of fibroids in post-puberty age women.

The fibroids cannot be just washed away at menopause. They may not even always disappear in post-menopausal women. In the absence of HRT treatment or addition of a progesterone preparation to the treatment protocol, there is a high probability of the fibroids at least shrinking and possibly disappearing in most women with pre-existing fibroids at the time of menopause.

Picture credit: BCCL

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Dr Rishma Pai


She is a consultant gynaecologist at Jaslok and Lilavati Hospital.

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