Meno-Pause! What’s going on with fibroids?

While most of us understandably do not feel crazy about some of the symptoms we know to accompany perimenopause and menopause, rumor has it that changing hormone levels in your body actually come with a surprisingly pleasant side effect; a shrinking of fibroids.

If you’re like me, you’re probably feeling sceptical about this ‘too good to be true’ side effect. Fibroids can’t really go away after menopause, can they? If so, what the heck is going on in our bodies to bring about these changes?

If you’re one of the 26 million women in the US who have fibroids, and you want to know whether perimenopause and menopause may be that silver bullet you’ve been searching for, keep reading!

Women are often told that their fibroids will shrink after menopause because levels of estrogen and progesterone begin to decline during this transition.

Just like other conditions we face throughout our lives, fibroid development depends on the activity of these hormones in our bodies. Higher levels of estrogen and progesterone have been associated with fibroid growth, and in turn symptoms such as pain and abnormal uterine bleeding (AUB).

On the flipside, lower levels of estrogen and progesterone (as is common during perimenopause and menopause) are thought to lead to fibroid shrinkage, as well as fewer and milder symptoms.

These hormonal dynamics are the reason why doctors may suggest treatment such as gonadotropin releasing hormone (GnRH) agonists to treat symptoms of fibroids in the first place. Nice stable levels of certain hormones means fibroid growth is minimized, and the experience of other fibroid-related symptoms can be improved.

If you were excited to find out that going through menopause might result in smaller, less symptomatic fibroids, I’m right there with you.

Those of us who have to deal with fibroid-related symptoms like AUB, painful periods, and difficulty sleeping or having sex can relate to the want for relief from these types of debilitating symptoms.

However, there are many details about the relationship between fibroids and menopause that needs to be acknowledged in order to really understand what’s going on – the fibroid fine print.

Let’s start off by tackling the most common misunderstandings:

1. Your fibroids don’t just go away after you’ve gone through menopause.
   Your fibroids tend to get smaller, and fibroid-related symptoms you experience become less intense as a result after you go through menopause.
2. While fibroids usually get smaller, in some cases women notice their fibroids actually grow after go menopause.
   Scientists admit that they don’t have the full story here, but they do point to a connection between fibroid development and body fat. Having more body fat is thought to lead to higher levels of estrogen in our bodies, which creates a supportive environment for fibroids to develop and grow.
3. You’ll be less likely to develop “new” fibroids after menopause.
   While this can happen, it’s very rare. So rare in fact, that if new fibroids did develop in your uterus after menopause, doctors would probably want to study you to have a better understanding of why this has happened!

It’s also important to point out that while fibroid symptoms become less disruptive after menopause, they actually seem to peak during perimenopause!

Women are at the highest risk of developing fibroids, and experiencing symptoms like pain and AUB during perimenopause.

This period of time can be difficult for women, because estrogen levels are spiking and dipping unpredictably, causing symptoms like irregular periods, hot flashes, and insomnia. Estrogen surges during perimenopause can be frustrating, as they lead to more fibroid-related symptoms than in other periods of our lives.

Perimenopause and menopause is no joke. Not only do hormonal changes trigger symptoms that affect everything from sleep to sex, but dipping hormone levels mean that bone health, brain activity, and heart health are all left struggling too.

While symptoms are usually manageable with the use of hormone therapy (HT), you may be hesitant to consider treatment if you also have fibroids because of the link between hormones and fibroid growth.

Is there really a link you should be concerned about though? HT involves replacing the estrogen, progesterone, and in some cases, testosterone that your body is naturally losing as a consequence of perimenopause and menopause. Adding these hormones back into your body means you’ll be able to lessen symptoms like hot flashes, heart palpitations, and migraines.

However, as these are the same hormones known to promote fibroid growth, shouldn’t women who have fibroids be avoiding these medications? Unfortunately, the stock ‘it’s complicated’ response needs to be called on here. Fundamentally, there just doesn’t seem to be agreement among clinicians or researchers as to whether HT contributes to fibroid regrowth, or if these medications worsen fibroid symptoms.

Researchers currently suggest that even if you have fibroids, you can try out HT if you think you would benefit from it – as long as you and your doctor monitor the situation. The current recommendation is to have an ultrasound every three months to see how the size of your fibroids change in response to HT. If they start to grow back, you’ll need to continue to monitor the growth or stop taking the medications. If not, let the HT good times roll!

If HT doesn’t sound like the medication for you, your doctor may alternatively suggest that you try using selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications target are more commonly used to treat conditions like depression, anxiety, and obsessive-compulsive disorder (OCD).

While SSRIs and SNRIs won’t address the hormonal changes that are causing you to experience symptoms of menopause, they can be used to treat the mood-related symptoms that you may experience during your menopausal transition.

People don’t often think about the benefits of menopause, but there are definitely upsides to this transition.

For one thing, we won’t have to worry about periods anymore. That means no more tracking cycles, worrying about bleeding through clothes, or any of the numerous other concerns that come with having periods.

We can also have sex without worrying about getting pregnant. That’s definitely a cause for celebration in my books!

The declining levels of estrogen and progesterone that we notice during and after menopause can also lead our fibroids to be more easily managed (Hooray!). That being said, you probably won’t even notice these benefits if your menopause symptoms take over as a new source of concern.

The good news is that you don’t have to choose between your fibroids and menopause, as both conditions are quite treatable.

If you have fibroids and are going through perimenopause and menopause it’s worth talking to your doctor. You deserve to live symptom-free, and when you think about it, you might only be a couple of conversations away from that reality.

Relief is in reach, so reach out!