Fibroids After Menopause: Do They Shrink, and Does Hormone Therapy Make Them Grow?

Fibroids are noncancerous growths in the uterus that feed on estrogen and progesterone. When periods stop and hormone levels drop, many fibroids shrink and symptoms ease. But if you’re thinking about hormone therapy, or you already have fibroids, you may wonder what happens next. Our guide to what fibroids are covers the basics.

Fibroid surgery becomes less common after menopause

A U.K. study followed more than 600,000 postmenopausal women for about 11 years.¹

• About 1 in 200 women aged 50 to 54 had surgery for fibroids within five years, falling to 1 in 1,000 at ages 75 to 79.¹
• At 50 to 54, the rate was about a quarter of that in women the same age who hadn’t reached menopause.¹

So fibroids become much less of a problem after menopause, but they don’t disappear for everyone.¹

What raised the risk

• Hormone therapy: women who had ever used it were about 2.3 times as likely to need fibroid surgery.¹
• Obesity: about 1.5 times as likely.¹
• Both together carried the highest risk, about 3.3 times.¹

The authors called obesity and hormone therapy important risk factors that can be changed.¹

Can you take hormone therapy if you have fibroids?

A 2019 review of 17 studies, including 9 randomized trials, found the evidence conflicting.² It concluded that fibroids aren’t an absolute reason to avoid hormone therapy, but:²

• women with fibroids on hormone therapy should be checked periodically
• hormone therapy should be stopped if fibroids grow
• the lowest effective dose of progestin should be used

The studies looked at many regimens, including skin patches, different progestins and related medicines such as tibolone and raloxifene.²

Questions to ask

1. How big are my fibroids, and where are they?
2. Which hormone therapy regimen is least likely to make them grow?
3. How often should we check them with an ultrasound?
4. What would a growing fibroid after menopause mean for me?

Our guides to pelvic ultrasound, bleeding after menopause, estrogen pills versus patches and fibroid embolization versus myomectomy explain related decisions.

Try: “I have two fibroids and want to start hormone therapy for hot flashes. Which option is safest for my fibroids, and when should we recheck them?”

Period, Handled includes a Period Scorecard and a visit script. Use them to record fibroid sizes, scan dates and any bleeding or pressure symptoms. See the book.