Shantel* was already aware that she had fibroids. She and her doctor had monitored the four or five golf ball-sized tumors in her uterus and how they—while painless at first—were the reason for her heavy menstrual bleeding and painful cramping. But when she started menopause, Shantel’s symptoms gradually disappeared. The bleeding stopped; the pain faded. And just like many medical sources suggested, it seemed as though her fibroids were no longer causing problems. For a few years, Shantel felt like her fibroid journey was over, which was perfect timing since she was now managing menopause symptoms with hormone replacement therapy (HRT). But then the unexpected happened: the menstrual bleeding returned. In that moment, Shantel discovered a truth that surprises many women—fibroids after menopause are possible, especially if HRT is involved.
The first aspect to understand is it is not a given that fibroids will go away during menopause. Most clinicians believe they are likely to shrink and can become asymptomatic, which stands to reason since this is a period when hormone levels are much lower. That said, some women may still experience discomfort, even after menopause. And while hormone replacement therapy does not cause fibroid pain to return in every instance, it can increase the risk.
A Quick Guide to Fibroids After Menopause
Researchers estimate that 70-80% of all women develop fibroids between 35 and 54. These non-cancerous tumors grow from the muscle tissue of your uterus. While they can be painless for some women, they tend not to stay the same size and can multiply. So, while it is possible to be diagnosed with just one fibroid, it is significantly more common to have several fibroids at once—all in varying sizes and locations in the uterus.
As a result, a woman can go from having no symptoms to experiencing a wide range of discomfort:
- Heavy or abnormal menstrual bleeding
- Painful periods, debilitating cramps, pelvic pain, and pressure
- Painful intercourse
- Fatigue and weakness
- Bloating or swelling in the lower abdomen
- Back or leg pain
- Urinary frequency, constipation, diarrhea, and rectal discomfort
There is still so much to learn about fibroids, but one thing doctors agree on is that they are under hormonal control, specifically estrogen and progesterone. The higher your hormone levels are, the higher the likelihood that your fibroids will have fuel to grow and cause problems. This is why fibroids tend to grow more during childbearing years, because hormone levels are typically at their peak during this time.
Menopause has the opposite effect because there is a natural decline in reproductive hormones during this stage of your life. This sudden drop in reproductive hormones can cause fibroids to shrink and prevent new ones from forming. Think of it as if your body is suddenly eliminating your fibroid’s food source. Without it, they generally can’t survive. Menopause is diagnosed after you experience 12 months without a period and typically starts between the ages of 45 and 55. While a natural part of life, menopause is not something women look forward to—even with its positive impact on fibroids. This is because menopause comes with symptoms of its own that can range from hot flashes and vaginal dryness to irregular periods and sleep disturbances.
Additional menopausal symptoms include:
- Weight gain
- Mood changes, including depression and anxiety
- Chills and night sweats
- Joint aches
- Insomnia
- Painful sexual intercourse
- Brain fog
With all of this said, menopause is not a guaranteed cure for fibroids. In other words, it is conceivable—just as Shantel’s story showed us—that you could experience uterine fibroid symptoms after the start of menopause. It is important that if you already have fibroid symptoms, and you are approaching the stages of perimenopause and menopause, leaving your fibroids untreated can cause unpleasant symptoms of fibroids after menopause.
The Surprising Link Between Hormone Replacement Therapy (HRT) and Fibroids
While lower hormone levels are significant in terms of cutting off fuel to your fibroids, it can have the opposite effect during menopause and lead to many of the menopausal symptoms mentioned above. The lower your hormone levels become, the worse the symptoms can get. The good news is that women going through menopause have options to combat these uncomfortable symptoms. One of those is hormone replacement therapy.
Also known as HRT or HT, hormone replacement therapy essentially replenishes depleted estrogen, progesterone and sometimes testosterone that your body is not making enough of during this season of life. As hormone levels rise, most women find meaningful relief from their symptoms. Hormone replacement therapy can come in many forms, including pills, gels, patches, injections, creams, rings, or long-acting pellets implanted under the skin. The specific method depends on the type of hormone, desired effects, and individual health considerations.
The tradeoff for women with fibroids is that their once dormant or shrunken tumors now have fuel to regrow. This was demonstrated in a three-year clinical study examining the effects of HRT on uterine fibroid growth in postmenopausal women. In the study, 37 postmenopausal women with fibroids received a daily dose of HRT. The results? Fibroid volume increased significantly after one year for HRT users and non-users. These increases continued significantly in HRT users in the second year but not in non-users. However, the volumes declined substantially in the third year to similar levels as those measured at baseline in control. In HRT users, fibroid volume significantly increased at the third year (vs. baseline) but declined insignificantly in comparison with the second year.
Clinically, at the end of the third-year study, one of 34 Non-HRT users and three of 34 HRT users increased fibroid volume over 25% compared with baseline in HRT non-users and users, respectively.
Granted, this does not happen to everyone using hormone replacement therapy, but it does happen often enough that women with a history of fibroids need to be informed and monitored closely.
Will I Be in More Pain With Fibroids After Menopause?
- Obesity — Excessive weight gain, including a diet heavy in red, processed meat, high-fat dairy products, salty foods, and certain carbohydrates, causes fibroids to grow.
- Family history of fibroids — Studies show that there is a consistent link between fibroids and heredity. So, if your mother, grandmother, or sister had fibroids, you are predisposed. In fact, the OWH says your risk of also experiencing them is roughly three times higher.
- Ethnicity — Black women are three times more likely to develop fibroids than any other ethnic group.
What To You Do If You Experience Returning Fibroids After Menopause
For women like Shantel, the return of fibroids after menopause can feel confusing and unfair. You were told this chapter was over. And for a while, it was. But if you are using HRT, your body may respond to the reintroduced hormones—and dormant fibroids may respond, too.
It does not mean you made the wrong choice. It simply means your treatment plan may need fine-tuning.
If you experience new or recurring symptoms after starting hormone replacement therapy, consider these steps:
- Schedule an ultrasound or MRI — Your gynecologist or interventional radiologist can confirm whether fibroids have grown, changed, or reappeared since your last evaluation.
- Reevaluate your HRT plan — In speaking with your doctor, they may suggest adjusting your current HRT dose, changing the delivery method, switching to a different type of therapy, or exploring non-hormonal symptom relief.
- Consider fibroid treatment options — Women have options when it comes to fibroid treatment. For years, the gold standard was to have a hysterectomy. Fast-forward to today, and other non-surgical options can include Acessa, Sonota, endometrial ablation, medications, and uterine fibroid embolization (UFE).
One of the most successful non-surgical treatment options is UFE (Uterine Fibroid Embolization). It does not technically remove uterine fibroids in the way surgery does. That said, it is more than 90% effective in relieving the fibroid symptoms by cutting off blood flow to all fibroids. This causes them to shrink and die, not just shrink. UFE is low risk, has no incision, and is faster than other options. And the best part is that it is an alternative to invasive surgeries such as a hysterectomy and myomectomy.
With UFE, small particles are introduced into the uterine arteries and fibroid vessels, blocking the blood flow to the fibroids. The procedure will last about one hour, and you will be asleep during the procedure. You can resume light activities as soon as you feel up to it.
Advantages of UFE at Fibroid Institute
- Covered by most major medical insurance
- No hospital stay
- Treat multiple fibroids at once
- No incision or vaginal access, just a small puncture on your wrist
- Recovery period is as little as one week in many cases
- Over 90% effective in reducing symptoms
- Concierge-level service
- 100% fibroid focused practice
- Direct access to your doctor before and after the procedure
Fibroid Institute Can Help With Fibroids After Menopause
Fibroids may quiet down during menopause, but they do not always disappear—and for women using hormone replacement therapy, symptoms can sometimes return when estrogen and progesterone are reintroduced. This does not mean you made the wrong choice in seeking relief from menopause symptoms. It simply means your fibroids may be more hormonally sensitive than most. Understanding the connection between fibroids after menopause, and HRT empowers you to make informed decisions about your care.
With proper monitoring and the right treatment approach, you can manage both menopause and uterine health confidently and comfortably. At Fibroid Institute, we set the standard of care for advanced fibroid treatment and help women achieve a fibroid-free life. We specialize in UFE because it delivers results in the least time and with minimal pain. On top of that, we simplify your UFE journey, managing everything from insurance to PCP communication and offering all patients physician-direct access before and after their procedure.
Very few practices across the country are dedicated 100% to fibroid treatment. That is where Fibroid Institute makes its mark. With multiple locations, our Houston and Dallas fibroid doctors help thousands of women avoid fibroid surgery and find relief from their fibroid symptoms. Our fibroid doctors are board-certified interventional radiologists and experts passionate about helping women become #FibroidFree. Meet some of these women here:
Because experience matters, our physicians have completed more than 40,000 interventional radiology cases over the course of a combined 55 years of experience. We invite you to connect with our highly specialized UFE treatment team who offers concierge-level care.
Most major medical insurance providers cover the cost of UFE. Get started now by calling our Dallas fibroid clinics at 214-838-6440, our Houston fibroid clinics at 713-903-3733, or by completing complete the form below.
Fibroid Institute Texas serves the Dallas and Houston metro areas including Richardson, Universal City, Spring, Kingwood, Stafford, Conroe, Texas City, Cypress, League City, Bellaire, Addison, Carrollton, Plano, Frisco, Craig Ranch, McKinney, Allen, Fort Worth, Grand Prairie, Hurst, Euless, Bedford, Arlington, Hutchins, Irving, Duncanville, DeSoto, Cedar Hill, Lancaster, Cockrell Hill, Highland Park, University Park, Park Cities, Garland, Mesquite, Dallas, Sherman, Houston, Sugar Land, Katy, Webster, Clear Lake, The Woodlands, and more.
Prior to starting any new treatment or if you have questions regarding a medical condition, always seek the advice of your doctor or other qualified health provider. This information is not a substitute for professional medical advice.
*Patient names and/or photos may be changed to protect patient confidentiality.
