Managing Uterine Fibroids During Menopause: To Operate or Not?

Q: Managing Uterine Fibroids During Menopause: To Operate or Not?

Hello： Each person's constitution and condition can vary, so it is essential for you to visit the outpatient clinic for an examination and have a thorough discussion with the physician. <br>Only then can the most appropriate treatment plan for your concerns be determined.

Menopausal fibroids

Hello, Doctor! I have a history of multiple uterine fibroids, heavy menstrual bleeding, and monthly menstrual pain that has never ceased.
Doctors have recommended surgery to remove both the uterus and the fibroids.
However, since I am approaching menopause and my symptoms are not as severe as before, I have been hesitant.
Over the past year, I have gradually felt much better, but I have been continuously monitoring the condition of the fibroids at two major hospitals.

The concern is that one doctor believes that monitoring for six months after menopause is sufficient, while another doctor insists that it would be better to remove the uterus because I am nearing menopause (still having menstrual cycles), and the fibroids have not decreased in size, which indicates a problem.

I would like to ask, will fibroids shrink quickly after menopause? My previous CA-125 levels were over 100, but they have been gradually returning to normal with each check-up.
Does this situation have any impact on the fibroids not shrinking after menopause? If I stop having menstrual cycles and truly enter menopause, but the fibroids remain the same size, would surgery still be necessary? Thank you!

Gengnianqi nüren, 50~59 year old female. Ask Date: 2016/04/19

Dr. Lin Wenbin reply Obstetrics and Gynecology

Hello: Each person's constitution and condition can vary, so it is essential for you to visit the outpatient clinic for an examination and have a thorough discussion with the physician.
Only then can the most appropriate treatment plan for your concerns be determined.

Reply Date: 2016/04/19

More Info

Managing uterine fibroids during menopause can be a complex decision, especially when considering surgical options. Uterine fibroids, also known as leiomyomas, are benign tumors that can cause a variety of symptoms, including heavy menstrual bleeding, pelvic pain, and pressure symptoms. As women approach menopause, hormonal changes can significantly affect the size and symptoms of fibroids.

Understanding Uterine Fibroids and Menopause
During the reproductive years, fibroids are often influenced by estrogen and progesterone, hormones that stimulate their growth. However, as women enter menopause, the levels of these hormones decline, which can lead to a reduction in the size of fibroids. Many women report that their fibroids shrink and symptoms improve after menopause. However, this is not universal, and some women may continue to experience symptoms or have fibroids that do not shrink significantly.

Monitoring and Management Options
In your case, it sounds like you have been experiencing significant symptoms from your fibroids, including heavy menstrual bleeding and pain. The fact that you have been monitored by two different physicians, each with differing opinions on the necessity of surgery, is not uncommon. One physician may advocate for a conservative approach, suggesting that you wait until menopause is fully established, while the other may recommend surgical intervention due to the persistent size of the fibroids.

1. Fibroid Size and Symptoms: If your fibroids are not causing significant symptoms and are not growing, it may be reasonable to continue monitoring them, especially as you approach menopause. The fact that your CA-125 levels have normalized is a positive sign, as elevated CA-125 can sometimes indicate other issues, including ovarian cancer. However, it is essential to continue monitoring this marker and any other symptoms you may experience.

2. Timing of Surgery: If you are nearing menopause and your symptoms have improved, surgery may not be necessary. However, if you experience a resurgence of symptoms or if the fibroids are causing significant discomfort, surgical options such as a hysterectomy (removal of the uterus) or myomectomy (removal of fibroids) may be warranted.
3. Post-Menopausal Considerations: Once you reach menopause and if your menstrual cycles cease, the fibroids may shrink further. However, if they remain large and symptomatic, surgical options should be reconsidered. It is essential to weigh the risks and benefits of surgery, including recovery time and potential complications.

4. Consultation with Specialists: Given the complexity of your situation, it may be beneficial to consult with a gynecologist who specializes in fibroid management or a reproductive endocrinologist. They can provide a more tailored approach based on your specific circumstances, including your overall health, the size and location of the fibroids, and your personal preferences.

Conclusion
In summary, the decision to operate on uterine fibroids during menopause should be based on a comprehensive evaluation of your symptoms, the size of the fibroids, and your overall health. If your symptoms have improved and you are approaching menopause, it may be appropriate to continue monitoring. However, if symptoms return or worsen, surgical intervention may be necessary. Always ensure that you have open communication with your healthcare providers and feel comfortable discussing your concerns and preferences regarding your treatment options.

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