Calcified Fibroids Post Menopause and Fibroids: What to Know
Uterine fibroids (leiomyomas) are common, benign growths of the uterus. They tend to grow during the reproductive years under the influence of estrogen and progesterone and often shrink after menopause. As fibroids age and lose their blood supply, they can undergo degeneration and calcify—essentially becoming partially “hardened.” For most postmenopausal people, calcified fibroids are an incidental finding and cause no trouble. Still, any new pelvic symptoms after menopause deserve medical evaluation. This guide explains what calcified fibroids are, how they’re diagnosed, when they matter, and what to ask your clinician.
What are calcified fibroids—and why do they occur after menopause?
Fibroids are composed of smooth muscle and fibrous tissue in the uterus. As hormone levels decline around menopause, many fibroids stop growing and may shrink. Reduced blood flow can lead to tissue breakdown (degeneration). Over time, calcium deposits may form within the fibroid—this is a calcified fibroid. Calcification is a natural end stage for many long-standing fibroids and is not cancer.
Because calcified fibroids are less metabolically active, they typically remain stable in size. They may feel firm on exam and appear as dense, shadowing areas on imaging.
How common are fibroids after menopause?
Fibroids are extremely common, and many people have them without symptoms. Most shrink after menopause, but some persist, and calcification becomes more likely with time. Black women are affected more often and may have more severe symptoms across the lifespan. While calcified fibroids are usually harmless, new or changing symptoms after menopause should prompt a check-in with a healthcare professional.
Symptoms to watch for after menopause
Many calcified fibroids cause no symptoms and are found on pelvic ultrasound, CT, or MRI done for another reason. When symptoms occur, they can include:
- Pelvic pressure or a sense of fullness
- Lower abdominal or pelvic pain, sometimes localized to one side
- Urinary frequency or urgency (from pressure on the bladder)
- Constipation or difficulty with bowel movements (from pressure on the rectum)
- Visible or palpable abdominal mass in longstanding, larger fibroids
Important: Any vaginal bleeding after 12 months without periods (postmenopausal bleeding) is abnormal and warrants evaluation—even if you’ve been told you have fibroids. Fibroids rarely cause bleeding after menopause, so your clinician will want to rule out other causes, including endometrial changes.
Could it be cancer?
Uterine fibroids are benign. Uterine sarcomas (including leiomyosarcoma) are rare cancers that can sometimes mimic fibroids. There is no reliable test that can definitively distinguish a benign fibroid from a sarcoma before surgery, though clinicians use your history, exam, and imaging to assess risk. Red flags include a new or rapidly enlarging uterine mass after menopause, significant or unexplained pain, and atypical imaging features.
The U.S. Food and Drug Administration (FDA) has warned that when surgery is needed for presumed fibroids, certain tissue-fragmenting techniques (power morcellation) can spread an unsuspected uterine sarcoma inside the abdomen. As a result, if surgery is recommended, your surgeon may discuss approaches that avoid or contain tissue fragmentation. While the risk of hidden sarcoma is low, it is a key part of informed consent. See FDA safety communications for details (links below).
How doctors diagnose calcified fibroids
Evaluation starts with a medical history and pelvic exam, followed by imaging:
- Transvaginal ultrasound: First-line test. Calcified fibroids often appear as bright, dense areas that cast acoustic shadows.
- MRI: Helps characterize masses, map their location (submucosal, intramural, subserosal), and clarify uncertain ultrasound findings.
- CT scan: Not the primary tool for pelvic evaluation, but may reveal densely calcified uterine masses incidentally.
If you have postmenopausal bleeding, your clinician may perform an endometrial biopsy to evaluate the uterine lining, even if fibroids are present. Blood tests may be ordered if anemia or other issues are suspected.
Treatment options after menopause
Management depends on symptoms, fibroid size and location, your overall health, and your preferences.
- Watchful waiting (observation): Appropriate if you have minimal or no symptoms and imaging is reassuring. Periodic follow-up may include symptom checks and, if needed, repeat imaging.
- Medications for symptoms: Over-the-counter pain relievers (such as NSAIDs if safe for you) can help with pressure-related discomfort. Treat constipation proactively with fiber, fluids, and activity. Iron may be needed if anemia is present.
- Uterine artery embolization (UAE/UFE): A minimally invasive radiology procedure that reduces blood flow to fibroids, shrinking them over time. It can be effective in appropriately selected patients after menopause, though heavily calcified fibroids may respond less because they are already poorly vascularized. An interventional radiologist can advise based on imaging.
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Surgical options:
- Hysterectomy (removal of the uterus) offers definitive relief from fibroid-related symptoms and is often considered if symptoms are significant after menopause or if there is concern about malignancy.
- Myomectomy (removal of fibroids only) is less commonly chosen after menopause but may be considered in select cases.
- Energy-based therapies: Options like radiofrequency ablation are primarily studied in premenopausal patients with symptomatic fibroids. Their role in heavily calcified, postmenopausal fibroids is limited and individualized.
What about menopausal hormone therapy (MHT/HRT)?
Some people take hormone therapy to manage menopausal symptoms. Estrogen (with progestin if you have a uterus) can, in some cases, stimulate fibroid tissue. Many postmenopausal fibroids still remain stable on standard-dose therapy, but new or worsening bleeding or pelvic pressure should prompt reassessment. Work with your clinician to balance symptom relief with fibroid monitoring, and use the lowest effective dose for the shortest duration that meets your goals.
When to seek care—and what to ask
See a clinician if you have:
- Any vaginal bleeding after menopause
- New or worsening pelvic pain, pressure, urinary or bowel symptoms
- A rapidly enlarging abdominal or pelvic mass
- Unexplained weight loss, fatigue, or anemia
Questions to bring to your appointment:
- Are my symptoms likely due to fibroids, and are they calcified?
- Do I need additional imaging (ultrasound vs MRI)?
- What are the pros and cons of observation vs treatment for me now?
- If surgery is considered, how will tissue be removed safely, and what are the risks?
- How might hormone therapy or other medications affect my fibroids?
Trusted sources and further reading
- American College of Obstetricians and Gynecologists (ACOG) – Uterine Fibroids: https://www.acog.org/womens-health/faqs/uterine-fibroids
- NIH MedlinePlus – Uterine Fibroids: https://medlineplus.gov/uterinefibroids.html
- NICHD (NIH) – Uterine Fibroids: https://www.nichd.nih.gov/health/topics/uterine
- National Cancer Institute (NCI) – Uterine Sarcoma: https://www.cancer.gov/types/uterine
- U.S. FDA – Laparoscopic Power Morcellation Safety Communications: https://www.fda.gov/medical-devices/safety-communications
Disclaimer: This article is for educational purposes and is not a substitute for personal medical advice. Always consult your clinician for guidance tailored to your health.
