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Fibroids are very common in women and in this patient information leaflet My Menopause Centre's Dr Abbie Laing explains what they are, symptoms, diagnosis and management, what happens to them after the menopause and more.
A fibroid is a non-cancerous (benign) growth of the muscle tissue in the womb (uterus). They can vary in size and can be small like a pea or large like a grapefruit.
Fibroids can sometimes be called uterine myomas, fibromyomas or leiomyomas. These are all different medical words for describing fibroids.
Fibroids are very common, and it is estimated that approximately 40% of women develop them.
It is not clear why fibroids develop but they have been linked to oestrogen and progesterone exposure. There also appears to be a genetic predisposition for some women.
Fibroids can occur anywhere in the womb and are named according to where they grow:
Fibroids that are intramural or subserous in position are less likely to cause bleeding problems.
Ultrasound is usually used to diagnose and assess fibroid size and position. If very large they can be sometimes felt through the skin by pressing on the lower abdomen or pelvis.
For most women, fibroids do not cause any symptoms and they are found by chance, for example during an ultrasound scan or as part of an examination. When symptoms occur these might include:
If a fibroid is causing few or no symptoms it can be left alone. Sometimes repeat scans may be needed to assess for any fibroid growth.
Not all women with fibroids will need surgery. Surgery is usually only recommended if fibroids are causing significant symptoms such as very heavy bleeding that has not got better with other treatments.
It is very rare for a fibroid to become cancerous (around 1/1000).
After the menopause fibroids usually shrink. MRI studies demonstrate that they can shrink by as much as 40%. This is thought to occur due to dropping levels of oestrogen and progesterone.
However, the shrinkage of fibroids might be smaller if you take hormone replacement therapy (HRT) and, for a small number of women, use of HRT may be associated with an increase in volume of existing fibroids. HRT is not associated with the development of new fibroids.
Despite this most women with fibroids can take HRT without any problems. This is because the level of hormone supplied by HRT is very low. Fibroids are therefore not a contraindication to HRT. However, where there are concerns, it would be important to monitor for any fibroid-related symptoms and arrange regular follow-up for review.
You can read more about fibroids here: https://www.nhs.uk/conditions/fibroids/
Dr Abbie Laing
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Panay N et al. Managing the menopause. Second Edition. Cambridge University Press 2020.
Hillard T et al. Management of the menopause. Sixth edition. British Menopause Society 2017.
Stewart EA et al. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124:1501-12.