Fibroid After Menopause: Understanding the Risk and Treatment Options
Fibroids or Uterine Fibroids, medically referred to as Uterine Leiomyomas, are muscular growths that form in the uterus.
Fibroids develop as benign tumors of the smooth muscle cells and are non-cancerous in nature.
There is a high occurrence of Uterine Fibroids among women of fertile age, particularly those in the 40 and above age group.
Though fibroids regress after Menopause, there is some possibility of their postmenopausal existence.
Read on to gather a better understanding of Uterine Fibroid after Menopause and available treatment options.
Understanding Uterine Fibroids and their symptoms
Uterine Fibroids appear as individual or multiple growths made up of smooth muscle tissue, either on the outer surface or within the muscular wall of the uterus.
As many as 80% of women experience fibroids during their lifetime.
Uterine Fibroids are asymptomatic in the majority of women, and it is common for them to go undetected.
Symptomatic women experience similar complications in pre and post-menopausal phases and typically complain about abnormal uterine bleeding.
Other symptoms related to Uterine Fibroids may include:
- Painful periods
- Dyspareunia (genital pain during or after sexual intercourse)
- Non-cyclic pelvic pain.
- A feeling of fullness in the pelvic area
- Lower back pain
- Frequent urination
Understanding Uterine Fibroid after Menopause
One striking characteristic of Uterine Fibroids is their reliance on ovarian hormones.
The occurrence of Uterine Fibroids peaks in the Perimenopausal years and subsequently decreases following Menopause.
The growth rate of fibroids in women under age 35 is twice as fast compared to women who are 35 years or older.
Evidently, as the reproductive Hormones drop significantly after Menopause, fibroids are normally expected to decline as well, and they do in most cases.
However, there is still a definite possibility of the persistence of Uterine Fibroid after Menopause.
While the exact cause remains elusive, substantial evidence suggests that the presence of Estrogen and Progestogens influences the growth of fibroids.
This is because the underlying pathology still exists even after Menopause is achieved.
Genetics is also believed to contribute to fibroid’s formation and subsequent growth.
Another possible factor that may contribute to the growth of fibroid after Menopause is Hormone Therapy(HT), as it involves the administration of reproductive hormones.
Treatment options
If fibroids are not causing any symptoms, there is typically no need for treatment.
The general approach when women are asymptomatic or have mild symptoms is to keep a careful watch on the symptoms.
However, medical and surgical interventions can be prescribed if the symptoms are severe and affect a woman’s general well-being.
The first approach is to alleviate the symptoms using medications, especially in cases where pregnancy is still desired.
Hysterectomy, i.e., removal of the uterus, is the treatment of choice for women who do not intend to get pregnant.
Let’s look at the surgical and non-surgical treatment measures available for uterine fibroid after Menopause.
Medicinal measure
Medicinal interventions can be considered to help shrink fibroids and alleviate the symptoms.
Aromatase inhibitors
Aromatase inhibitors, such as Letrozole, are a class of drugs with an antiestrogenic effect that may prove useful in treating UFs.
These medicines aim to alleviate the symptoms such as uterine bleeding.
Selective Estrogen Receptor Modulators (SERMs)
SERMs such as Raloxifene and Tamoxifen result in a tissue-specific action through mixed agonist and antagonist effects on Estrogen receptors.
They have shown efficacy in suppressing the severity of abnormal urinary bleeding and decreasing the size of Uterine Fibroid after Menopause.
Selective Progesterone Receptor Modulators (SPRMs)
Studies have indicated that SPRMs can help reduce the size of fibroids.
Hence, they can be considered as a possible measure to tackle fibroid symptoms after Menopause.
Gonadotropin-releasing Hormone Analogues (GnRHas)
GnRHas, such as Lupron, can be given by injection, nasal spray, or implanted.
These drugs shrink the fibroids and prove to be effective in minimizing the fibroid symptoms after Menopause.
Combination Oral Contraceptives (COCs)
Observational data indicate that the use of oral contraceptives can be beneficial in reducing bleeding symptoms for women with Uterine Fibroid after Menopause.
COCs can improve heavy menstrual bleeding associated with fibroids, primarily through their suppressive effects on endometrial proliferation.
Pain relievers
Over-the-counter drugs such as Acetaminophen and Ibuprofen can be used for mild pain caused by Uterine Fibroid after Menopause.
Minimally Invasive methods
If medicinal interventions prove inadequate in addressing the effects of fibroids after Menopause, advanced measures may be needed to manage the condition.
However, minimally invasive approaches should be considered before opting for a surgical procedure as they are less challenging and carry lower risks.
Here are a few such measures that can be opted for:
Myolysis
Myolysis is a minimally invasive technique used to reduce the size of fibroids after Menopause
It involves heating the fibroid (Thermal Myolysis) or cooling it (Cryomyolysis) to a point where it is no longer viable
A needle, typically guided by laparoscopy, is inserted into the fibroids to administer either electric current or freezing, effectively destroying the fibroids
A reduction in the volume of the fibroids can be achieved with this process.
Radiofrequency ablation
Radiofrequency ablation is another minimally invasive option that can be used to treat Uterine Fibroid after Menopause.
This technique involves the destruction of the Myoma tissue by inserting a needle electrode, guided by either ultrasound or laparoscopy, into the fibroid.
Heat energy is then applied to induce cell death and tissue necrosis.
Radiofrequency ablation can be considered another form of Myolysis.
Magnetic Resonanceâguided Focused Ultrasound Surgery (MRgUS)
It is an interventional radiologic technique that utilizes high-energy focused ultrasound waves in a pulsatile manner to heat and eliminate the fibroid.
Uterine Artery Embolization (UAE)
UAE is also an interventional radiological technique that can be used to treat Uterine Fibroid after Menopause.
To carry out this procedure, a catheter is inserted into the femoral artery (major blood vessel located in the thigh) and then guided to the affected uterine artery.
Once the desired location is reached, an embolizing or blocking agent is introduced, resulting in irreversible damage to the fibroid.
Surgical Interventions
Medications may not yield satisfactory results, or fibroids may grow back in some cases.
Surgical options may be considered a more aggressive approach.
Here are ways to manage the condition surgically:
Myomectomy
Myomectomy is a surgical procedure involving the elimination of the fibroids themselves.
This procedure leaves the uterus intact, hence can be a preferred option for those who desire natural or assisted pregnancy.
This can be performed abdominally, laparoscopically, or vaginally.
Hysterectomy
The most effective and lasting treatment for Uterine Fibroid after Menopause is Hysterectomy.
A hysterectomy is a surgical intervention that involves the removal of the uterus.
It is the preferred treatment option in case of large fibroids and severe bleeding and the individual does not wish to become pregnant.
Alternate Treatment options
A study has supported the inhibitory effect of some botanical drugs and ingredients.
Some of them include:
- Curcuma longa, commonly known as turmeric, depicts anti-uterine fibroid activity
- Camellia Sinensis or green tea extract may help in the reduction of the fibroid volume
- Scutellaria Barbata (SB) is a herb of the mint family, a traditional Korean Medicine that exhibits anti-inflammatory, antitumor properties and inhibits fibroid growth.
- Fragaria x Ananassa or Strawberry extract has also exhibited potential as a therapeutic and/or preventive agent against Uterine Fibroid after Menopause.
Summary
Development of fibroids is possible even after Menopause.
Though the exact cause behind this is unclear, hormones are believed to play a primary role.
Hormonal Therapy can be another contributing factor to fibroid after Menopause, as they involve the administration of reproductive hormones.
In most cases, Uterine Fibroid after Menopause is asymptomatic, but some individuals may experience mild to severe symptoms.
The initial treatment approach is typically focused on alleviating symptoms through medication.
Aromatase Inhibitors, SPRMs, SERMs such as Tamoxifen and GnRHas have demonstrated significant efficacy.
If preventive measures are insufficient, minimal invasive measures and surgical procedures are considered.
Certain botanical drugs such as turmeric (Curcuma longa), and green tea extract (Camellia Sinensis) have also shown inhibitory effects on fibroid after Menopause.
Each case of Uterine Fibroid after Menopause is unique and requires individual analysis and treatment; therefore, consultation with a doctor is essential.
Frequently Asked Questions
What causes fibroids to grow after Menopause?
Though the exact cause of fibroid growth after Menopause is not clear, Hormonal activity in the body has been associated with it. Hormone Therapy may also be linked with their growth as they involve Estrogen and Progesterone Hormones administration.
Should fibroids be removed after Menopause?
After Menopause, fibroids often naturally shrink or become less bothersome. However, if fibroids after Menopause cause significant discomfort, their removal may be considered. Deciding whether to remove fibroids depends on factors like symptoms, their severity, and the patient’s age and should be made in consultation with a medical expert.
How do you treat fibroids after Menopause?
Treatment options for fibroids after Menopause include Hormonal medications, non-invasive procedures like Uterine Artery Embolization, and surgical interventions such as Myomectomy or Hysterectomy. Treatment selection depends on the severity of symptoms and individual circumstances and should be discussed with a medical professional.
How can I shrink fibroids naturally after Menopause?
Several botanical drugs, such as turmeric (Curcuma longa), green tea extract (Camellia Sinensis), and Scutellaria Barbata herb, have demonstrated the potential to inhibit fibroids after Menopause. However, it is important to note that their effectiveness is still being researched, and you are advised to consult your doctor before deciding on the treatment best suitable for you.
