Uterine Fibroids and Menopause: An Essential Guide for Women

Abstract

Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that develop in the muscular wall of the uterus. While they commonly affect women during their reproductive years, the transition to menopause brings significant changes in their development and management. This article explores the relationship between uterine fibroids and menopause, delving into symptoms, causes, treatment options, and what women can expect during this critical life stage. Our aim is to provide an easy-to-understand yet comprehensive guide to help women make informed decisions about their health.

Introduction

Uterine fibroids affect a significant number of women worldwide, with estimates suggesting that up to 70% of women will develop them at some point in their lives (Stewart, 2015). For African women, the prevalence is even higher, with studies indicating a rate exceeding 80% (Okolo, 2008). Though fibroids are benign, their symptoms can range from mild to severe, often disrupting a woman’s quality of life.

As women approach menopause, hormonal shifts influence the behaviour of these fibroids. This transitional period raises many questions: Will the fibroids shrink? Do symptoms improve or worsen? What treatment options are available?

This paper seeks to answer these questions in an accessible manner, breaking down complex medical terms for the general public while retaining the integrity of scientific knowledge.

What Are Uterine Fibroids?

Uterine fibroids are solid growths made of smooth muscle cells and connective tissue. They vary in size, ranging from small, seed-like formations to large masses that can distort the uterus. Fibroids can be classified based on their location within the uterus:

• Submucosal fibroids: Develop under the lining of the uterus and can protrude into the uterine cavity.
• Intramural fibroids: Found within the muscular wall of the uterus.
• Subserosal fibroids: Located on the outer surface of the uterus.

Causes of Uterine Fibroids

The exact cause of fibroids remains unclear, but several factors contribute to their development:

• Hormonal Influence: Oestrogen and progesterone, the hormones that regulate the menstrual cycle, play a key role in fibroid growth.
• Genetics: Family history increases the likelihood of developing fibroids.
• Lifestyle and Diet: High-fat diets and obesity are associated with increased risk.

Uterine Fibroids During Menopause

Do Fibroids Shrink After Menopause?

The role of oestrogen and progesterone in fibroid growth means that fibroids often shrink after menopause when hormone levels decline. However, not all fibroids behave the same way. For some women, symptoms persist or even worsen due to other factors such as hormone replacement therapy (HRT) or pre-existing large fibroids.

Common Symptoms During Menopause

• Abnormal Bleeding: Spotting or heavy bleeding, though rare, can occur.
• Pelvic Pressure or Pain: Large fibroids may cause discomfort even after menopause.
• Urinary Symptoms: Frequent urination or difficulty emptying the bladder may persist.
• Constipation: Fibroids pressing on the rectum can lead to bowel issues.

Diagnosis and Monitoring

How Are Fibroids Detected?

Diagnosing fibroids typically involves:

• Pelvic Ultrasound: A non-invasive imaging test to view the uterus.
• MRI Scans: Provides a detailed look at fibroid size and location.
• Hysteroscopy: A procedure using a small camera to inspect the uterine cavity.

Why Monitoring Matters

Even after menopause, regular check-ups are essential, particularly for women with large fibroids. Rarely, fibroids may transform into cancerous growths, though the risk is less than 1% (Baird et al., 2017).

Treatment Options

Non-Surgical Approaches

• Medication: Drugs like gonadotropin-releasing hormone (GnRH) agonists can shrink fibroids temporarily.
• Lifestyle Changes: Maintaining a healthy weight and eating a balanced diet can help manage symptoms.

Surgical Options

• Myomectomy: Removes fibroids while preserving the uterus.
• Hysterectomy: Complete removal of the uterus, often recommended for severe cases.

Emerging Therapies

• Uterine Artery Embolisation (UAE): Cuts off blood supply to the fibroid, causing it to shrink.
• Focused Ultrasound Surgery (FUS): A non-invasive technique using high-frequency sound waves to destroy fibroids.

Living With Fibroids Post-Menopause

Emotional Well-being

The physical symptoms of fibroids can lead to anxiety and depression. Seeking support from friends, family, or counselling services can make a difference.

Self-Care Tips

• Exercise Regularly: Helps manage weight and improves overall health.
• Monitor Symptoms: Keep track of any changes and report them to your doctor.
• Educate Yourself: Stay informed about treatment options and advances in fibroid management.

Conclusion

For many women, menopause marks the beginning of relief from uterine fibroids as hormone levels drop. However, this is not a universal experience. Understanding the nuances of how fibroids interact with menopause is crucial for making informed decisions about health and treatment.

If you have concerns about uterine fibroids, speak to a healthcare provider. Remember, knowledge is power, and staying informed is the first step toward better health.

References

Baird, D. D., Dunson, D. B., Hill, M. C., Cousins, D., & Schectman, J. M. (2017). High cumulative incidence of uterine leiomyoma in African-American women: Ultrasound evidence. American Journal of Obstetrics and Gynecology, 188(1), 100-107.

Okolo, S. (2008). Incidence, etiology and epidemiology of uterine fibroids. Best Practice & Research Clinical Obstetrics & Gynaecology, 22(4), 571-588.

Stewart, E. A. (2015). Uterine fibroids. The Lancet, 357(9252), 293-298.

This article is tailored for women navigating uterine fibroids during menopause and aims to demystify the condition while offering practical advice for improved health outcomes.