Uterine fibroids and menopause

Q: Is there any possibility of uterine fibroids shrinking with menopause? I am 52 and feel a slight bulge in my abdomen at times.

A: One of the best things that happens with menopause is that fibroids most often shrink. Although we have absolutely no idea what causes fibroids, which are an exuberant growth of the smooth muscle wall of the uterus, we do know that estrogen feeds them. So when estrogen levels go down at menopause, fibroids tend to shrink. They may not disappear entirely, but they will decrease in size.

So if I have a friend who is 52 and skipping periods and getting hot flashes – even if she has fibroids the size of a grapefruit – I encourage her to hang in there and not have a hysterectomy, because with menopause they will bother her much less. The problem is that sometimes I will be dealing with a 52-year-old woman who has no signs whatsoever of becoming menopausal. If she is really bothered by symptoms from her fibroid, I am in more of a quandary, since there is no good test to find out when menopause will occur. My personal record is 59 – I have taken care of two women who finished menopause at 59. So I leave it up to the woman to decide whether she should think of surgery or not.

Interestingly enough, even if you give a woman with fibroids estrogen replacement therapy, the fibroids seldom increase in size, and usually they continue to shrink. Remember that the amount of estrogen we give when we do replacement therapy is much less than your own body makes with normal menstrual cycles. So a woman in this situation needs monitoring, but fibroids are not a contraindication to estrogen.

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