When most people think about perimenopause (the 5-10 years leading up to menopause), they probably think of menopausal symptoms like difficulty sleeping, hot flashes/night sweats, and weight gain…not fibroids. But these tumors (which are mostly always benign) are actually more prevalent than you may think. Here’s what you need to know:

What even are fibroids?

Fibroids (aka leiomyomas or myomas) are gynecologic tumors — which sounds scary, we know. But they’re mostly always benign, or noncancerous. Only in rare cases do new fibroids begin as cancer, but they can’t turn into cancer.

The tumor itself is composed of a whole lot of smooth muscle cells and connective tissue which develops inside the uterus. The size of the fibroids can vary from that of a small seed to a watermelon.

What are the symptoms of fibroids?

• Heavy bleeding
• Frequent urination
• Abdominal bloating & feelings of fullness/discomfort/cramping (although for temporary bloating, it’s very unlikely that the cause is fibroids)
• Lower back pain
• Painful sex and, in rare cases, infertility

How prevalent are fibroids during & after menopause?

The short answer: Fibroids during perimenopause are common, but fibroids after menopause? Not so much.

The long(er) answer:

An estimated 26 million women between the ages of 15 and 50 will develop uterine fibroids which, by some estimates, is 70-80% of the female population. But not everyone develops symptoms or requires treatment.

The prevalence of symptomatic uterine fibroids — or UF, for short — peaks during perimenopause and declines after menopause. (As a reminder, “menopause” is the moment in time when you’ve gone 12 months without a menstrual cycle, after which you’re considered postmenopausal.)

The reason? Fluctuating hormone levels. Fibroids depend on estrogen and progesterone to grow, which are at their highest during childbearing years of pre- and peri-menopause. When both of those hormones decrease after menopause, fibroids regress.

In a large women’s health cohort study of 133,000 California teachers, researchers found, among 1,790 women, more than 30% of newly-diagnosed UFs were among those between the ages of 45-49.

Risk factors for fibroids

• Race/ethnicity
  African American women are 2-3 times more likely than white women to experience uterine fibroids, and to develop them earlier in life with more severe symptoms that interfere with their personal and professional lives.
• Obesity
  Obesity, which is defined by the World Health Organization as a body mass index (BMI) over 30 kg/m2, has been found to double the risk of uterine fibroids in postmenopausal women irrespective of hormone replacement therapy (HRT) usage. Researchers hypothesize that the reason may be because obesity is correlated with a higher “estrogenic environment.”

Additional risk factors include family history of uterine fibroids, high blood pressure (hypertension), and vitamin D deficiency.

Fibroid treatment options

In more extreme cases, healthcare professionals may recommend a hysterectomy for fibroids.

Remember, there’s more than one type of hysterectomy: a total hysterectomy means that the cervix and uterus were both removed and a partial hysterectomy means that the uterus was removed but the cervix was left intact.

Today, however, we have more options that are less interventional to help shrink the size of uterine fibroids:

• Uterine fibroid embolization: a minimally invasive procedure that cuts off the blood supply, inhibiting fibroid growth
• Myomectomy: a procedure to remove fibroids while preserving healthy uterine tissue (for those still in their reproductive years who wish to have children post-treatment)

There are also a handful of medications available and worth discussing with your healthcare professional, such as:

• Tibolone
• Aromatase inhibitors
• Selective estrogen receptor modulators
• Selective progesterone receptor modulators

Think your symptoms may be due to fibroids? It’s worth consulting your healthcare provider to get a proper diagnosis and recommended course of treatment/management. Because if left untreated, heavy bleeding may result in anemia and chronic fatigue.

To learn more, we recommend this recording from Dr. Taraneh Shirazian, a world-renowned fibroid expert at NYU.