Managing Uterine Fibroids During Menopause: To Remove or Not?

A 10 cm uterine fibroid with menopausal estrogen replacement—Is it necessary to remove a fibroid that does not cause discomfort?

Hello Dr.
Tsao: (I apologize for sending the same message twice due to internet issues.) Two years ago, I was informed during a health check that I have an 8 cm fibroid, but since it hasn't caused any discomfort, I opted for monitoring.
Now it has grown to about 9-10 cm, which doesn't seem to be a rapid increase.
Recently, I haven't had my period for two months, and I realize there's a conflicting issue regarding menopause: I have a 10 cm fibroid, so I should avoid consuming estrogen-rich foods, but what if I need hormone replacement therapy during menopause? Would it be better to remove the uterine fibroid? Or should I just leave it as is? Will leaving it for a long time increase the risk of complications? Or are the postoperative complications more significant? I apologize for the lengthy message; it has made me more hesitant about whether to undergo surgery or not...

Chen Zhen, 40~49 year old female. Ask Date: 2016/06/10

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, generally, surgical intervention for tumors is considered when they are larger than 5 centimeters.
However, if there are no symptoms or discomfort, observation and regular monitoring can also be considered.
After menopause, engaging in more physical activity and maintaining a normal lifestyle is sufficient; dietary supplementation is not necessarily required.
Wishing you good health.

Reply Date: 2016/06/10

More Info

Managing uterine fibroids during menopause can be a complex decision, especially when considering factors such as the size of the fibroids, symptoms, and the potential risks associated with surgical intervention. In your case, you have an 8-10 cm fibroid that has not caused discomfort, and you are approaching menopause, which adds another layer of complexity to your situation.

First, it is important to understand what uterine fibroids are. Fibroids are non-cancerous growths of the uterus that often appear during childbearing years. They can vary in size and number, and while many women experience no symptoms, others may have heavy menstrual bleeding, pelvic pain, or pressure symptoms. The fact that your fibroid has remained asymptomatic is a positive sign, but its size (9-10 cm) is significant enough to warrant careful monitoring.

As you approach menopause, hormonal changes will occur, particularly a decrease in estrogen levels. Estrogen is known to stimulate the growth of fibroids, so many women find that their fibroids shrink after menopause. However, this is not guaranteed, and some fibroids can remain stable or even grow during this time. The concern about estrogen supplementation during menopause is valid, as it could potentially stimulate the growth of existing fibroids. If you are considering hormone replacement therapy (HRT) for menopausal symptoms, it is crucial to discuss this with your healthcare provider, who can help you weigh the benefits and risks in the context of your fibroid situation.

Regarding the decision to remove the fibroid or leave it in place, several factors should be considered:
1. Symptoms: If the fibroid remains asymptomatic and does not cause any issues, many healthcare providers may recommend a watchful waiting approach. Regular monitoring through ultrasound can help track any changes in size or symptoms.

2. Risk of Complications: While the risk of fibroids becoming cancerous is low, larger fibroids can sometimes lead to complications such as anemia from heavy bleeding or pressure effects on surrounding organs. If you notice any new symptoms, such as increased bleeding or pain, it may prompt a reevaluation of your treatment options.

3. Surgical Risks: Surgical removal of fibroids (myomectomy) or the uterus (hysterectomy) carries risks, including infection, bleeding, and complications related to anesthesia. Additionally, there can be long-term effects on hormonal balance and sexual function, especially if the uterus is removed.

4. Postoperative Recovery: Recovery from surgery can vary. Some women may experience significant relief from symptoms, while others may face challenges during recovery, including pain and emotional adjustments.

In conclusion, the decision to remove or leave the fibroid should be made collaboratively with your healthcare provider, considering your personal health history, the current state of your fibroid, and your future reproductive plans. If you are asymptomatic and approaching menopause, monitoring may be the best course of action. However, if you have concerns about potential complications or if your symptoms change, surgical options may need to be revisited. Always ensure that you have open communication with your healthcare provider to make the most informed decision for your health.

Similar Q&A

Managing Uterine Fibroids During Menopause: To Operate or Not?

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...

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.

Managing Uterine Fibroids: To Remove or Not to Remove?

Hello, I have been diagnosed with a uterine fibroid approximately 5 centimeters in size. During my last menstrual period, I experienced heavy bleeding. Is it necessary to undergo a removal procedure? A doctor suggested that I could have my uterus removed along with the fibroid, b...

Dr. Li Guanghan reply Obstetrics and Gynecology
Hello: Here are a few points for your consideration: 1. Have you tried medication for control? What was the effect? Were there any side effects? 2. Do you have any plans for future pregnancies? 3. If you choose to preserve the uterus while removing the fibroids, there is a possib...

Is Ovarian Removal Necessary with Uterine Fibroids?

Hello Dr. Lee, my mother (currently 51 years old and postmenopausal) is experiencing issues with uterine fibroids, which are approximately 7 to 8 centimeters in size. Recently, she has been suffering from frequent abdominal pain, and the pain relief medication has had limited eff...

Dr. Li Guanghan reply Obstetrics and Gynecology
Hello: For postmenopausal women, removing the ovaries can prevent ovarian cancer; however, some scholars advocate for their preservation, arguing that they can still secrete small amounts of hormones. Currently, both approaches have their proponents among physicians. Wishing you ...

Choosing Between Uterine Fibroid Removal and Hysterectomy: What to Consider

Hello, doctor. I am 49 years old. Last year, I discovered I had uterine fibroids after seeking medical attention for heavy menstrual bleeding. I took a medication called Danazol for nearly three months, but I found that it significantly affected my mood, so I stopped taking it. S...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, both options are acceptable. The likelihood of recurrence at the age of 49 should be low. Wishing you good health.