October is Menopause Awareness Month – done yearly with the goal of raising awareness about menopause and the challenges women face during this natural stage of life. In honour of this month, we’re taking a look at how menopause and its resultant hormonal changes affect fibroid growth and symptoms, as well as tips for managing it. Many women with fibroids know that fibroids are highly affected by oestrogen and progesterone[1], so many may breathe a sigh of relief, thinking that their journey with fibroids has come to an end. The reality, however, is that the journey may continue, just with a few different twists and turns along the way.
Transitioning into menopause and fibroids
Menopause which usually happens between the ages of 45 and 55, is officially declared when a woman hasn’t had her period for 12 consecutive months[2]. Before that though it’s likely that in the years leading up to it you will notice some changes. ‘Perimenopause’ is the official term for this transitionary period, marked by fluctuating hormone levels, irregular periods, and symptoms like hot flashes, night sweats, mood swings, and sleep disturbances[3].
During perimenopause, oestrogen levels can fluctuate dramatically. Since fibroids are oestrogen-dependent, these hormonal changes can influence their growth and associated symptoms. Some women may experience an increase in fibroid-related symptoms during this time, while others might notice a reduction. As menopause progresses and oestrogen and progesterone levels consistently decrease, many women find that their fibroids naturally shrink[4]. This can lead to a reduction in symptoms such as heavy bleeding, pelvic pain, and pressure. However, it’s important to note that this isn’t universal – some women may continue to experience fibroid-related issues even after menopause.
How do I know I’m menopausal and why don’t all fibroids shrink?
One thing that is not frequently talked about is the fact that distinguishing between fibroid symptoms and menopausal symptoms can sometimes be tricky, as there’s often an overlap. Common experiences include irregular bleeding, pelvic pain and pressure, an increased need to pee (urinary frequency) and fatigue. Keeping track of other symptoms indicative of menopause is key during this period, but in some cases, a doctor might order blood tests to check your hormone levels, particularly follicle-stimulating hormone (FSH) and estradiol (a form of oestrogen). High FSH levels and low estradiol levels are indicative of menopause[5].
So what happens if you’re confirmed to be menopausal but are still experiencing symptoms? In the words of Dr Paula Ramona – a gynaecologist and menopause expert, “if they are symptomatic, it means that something is going wrong with this myoma.”
There are several factors that may be to blame for continuing symptoms, but one of the most important to rule out first is cancer. Dr Ramona goes on to say that if fibroids continue to grow or bleed, it is perhaps because they are malignant, and surgical treatments should be considered to either rule this out or remove them. If you’re sure you’re menopausal but are still experiencing bleeding, it’s really important to relay this information to your healthcare provider so they can look into further testing.
Other reasons for continuing symptoms like pelvic pressure, the need to pee frequently, constipation or pain may be due to large pre-existing fibroids. These fibroids, even when starved of the hormones that fuel their growth, may not shrink significantly and can unfortunately continue to cause symptoms by pressing on the surrounding organs like the bladder or bowel[6]. Lastly, as fibroids shrink after menopause, they may undergo a process called degeneration[7], where the tissue breaks down. This can cause pelvic pain and discomfort. In some cases, degeneration may lead to localized inflammation or infection, contributing to post-menopausal symptoms.
In any of these cases, consulting with your gynaecologist and keeping a full record of your symptoms is crucial to find an effective (and comfortable!) way forward.
So what are my options for treatment and symptom management?
One of the common treatments you may have heard of to handle the symptoms of menopause including the hot flushes, night sweats and mood swings mentioned above, as well as others like vaginal dryness and bone density issues, is HRT (Hormone Replacement Therapy). Unfortunately, many HRT therapies are oestrogen-based, which may inadvertently stimulate fibroid growth[8]. If you’ve been diagnosed with fibroids and are with the same women’s healthcare practitioner, they should be aware of the potential risks and will likely proceed with caution or prescribe non-oestrogen therapies to help you through.
Beyond just hormone therapies, if your fibroids are still causing you issues you and your doctor can look into non-hormonal treatment options or minimally invasive procedures such as uterine artery embolization or focused ultrasound surgery to shrink fibroids without major surgery.
As always, maintaining a healthy lifestyle will give you the best results, both for managing your menopausal symptoms, as well as any residual fibroid symptoms. This includes maintaining a healthy diet, engaging in regular exercise, and stress management.
Looking ahead
Some good news is that emerging research continues to shed light on the behaviour of fibroids during menopause, potentially leading to new treatment options. Staying on top of regular check-ups and having open conversations about your symptoms can help you explore the best management strategies for this stage of life. Plus, it ensures you’re always in the loop about any new treatments that might become available!
