Can Fibroids Burst After Menopause and Fibroids: What to Know

Uterine fibroids (leiomyomas) are common, benign tumors of the uterus that affect up to 70–80% of women by age 50. After menopause, fibroids usually shrink because estrogen and progesterone levels decline. Still, many people worry about sudden complications—especially whether a fibroid can “burst.” Here’s what the science and clinical experience say, how to recognize warning signs, and when to seek care.

Can a Fibroid Burst After Menopause?

The short answer: true “bursting” is very rare at any age, and especially uncommon after menopause. What people often describe as a burst is more likely one of the following:

• Degeneration: When a fibroid outgrows its blood supply, it can break down (degenerate), causing acute pain that may last days to weeks. Degeneration is more common in pregnancy or during rapid growth, but can occur at other times.
• Torsion of a pedunculated fibroid: A fibroid on a stalk (pedunculated subserosal fibroid) can twist, cutting off its blood supply. This causes sudden, severe pain and requires urgent evaluation.
• Surface vessel rupture and internal bleeding (hemoperitoneum): Exceptionally rare, this involves bleeding from vessels over a fibroid into the abdomen. It’s a surgical emergency and has been reported mostly as isolated case reports.
• Expulsion of a submucosal fibroid: A fibroid within the uterine cavity can be pushed out through the cervix, causing cramping and bleeding. This scenario is uncommon after menopause.

Most postmenopausal fibroids reduce in size or become calcified and quiet. If you experience new, sudden, or severe symptoms after menopause, it’s important to be evaluated—not because bursting is likely, but because symptoms after menopause warrant careful assessment.

Red-Flag Symptoms: When to Seek Immediate Care

Call emergency services or go to the ER if you have:

• Sudden, severe lower abdominal pain, especially with a firm or tender abdomen
• Fainting, dizziness, rapid heartbeat, or signs of internal bleeding
• Any postmenopausal vaginal bleeding (bleeding after 12 months without a period)
• Fever with pelvic pain (possible infection)

Postmenopausal bleeding is never “normal.” While fibroids can cause bleeding, clinicians also need to rule out other causes, including endometrial hyperplasia or, rarely, cancer.

Why Fibroid Symptoms After Menopause Matter

Because fibroids usually shrink after menopause, new growth, new pain, or new bleeding should prompt medical review. A key reason is to exclude other conditions that can mimic fibroids or rarely coexist, such as endometrial pathology or uterine sarcoma. Uterine leiomyosarcoma is rare, but the risk of an occult sarcoma increases with age; evaluation helps ensure safe and appropriate treatment.

How Doctors Evaluate Postmenopausal Fibroids

• History and pelvic exam: To assess pain, bleeding, pressure symptoms, and uterine size.
• Imaging: Transvaginal ultrasound is the first-line test; MRI may clarify number, size, and location of masses or help differentiate fibroids from other conditions.
• Lab tests: Blood counts if bleeding is suspected; other labs as needed.
• Endometrial assessment: If there is postmenopausal bleeding, clinicians often recommend endometrial biopsy and/or sonohysterography to rule out intrauterine pathology.

Treatment Options After Menopause

Management depends on your symptoms, fibroid characteristics, overall health, and preferences.

Watchful Waiting

If fibroids are small and asymptomatic, observation is appropriate. Many postmenopausal fibroids continue to shrink or calcify.

Medications

• Pain control: Short courses of NSAIDs can help with cramping or degeneration-related pain, if safe for you.
• Hormone therapy (HRT): Systemic estrogen therapy can sometimes stimulate fibroid growth. If you use or are considering HRT, discuss risks and monitoring with your clinician.
• Drugs used to shrink fibroids before menopause (e.g., GnRH agonists) have limited roles after menopause and are typically not first-line for long-term management.

Minimally Invasive and Surgical Procedures

• Uterine artery embolization (UAE): A nonsurgical procedure that blocks blood flow to fibroids, shrinking them. It can be an option for symptomatic patients who wish to avoid surgery.
• Myomectomy: Surgical removal of fibroids. Less common after menopause unless there’s a specific indication.
• Hysterectomy: Removal of the uterus is definitive and eliminates fibroid-related symptoms and recurrence. It may be recommended for persistent symptoms, rapidly growing masses, or when malignancy cannot be ruled out.

Important safety note: If hysterectomy or myomectomy is performed minimally invasively, some techniques use power morcellation to break up tissue for removal. The U.S. Food and Drug Administration (FDA) warns that power morcellation can spread unsuspected cancer within the abdomen. When used, the FDA recommends contained systems and careful patient selection. Discuss with your surgeon whether morcellation is planned and what alternatives exist.

Living Well With Fibroids After Menopause

• Track any pelvic pain, pressure, urinary frequency, or changes in bowel habits.
• Report any postmenopausal bleeding promptly.
• Keep routine gynecologic visits and recommended imaging follow-up.
• If on HRT, ask about a schedule to monitor fibroid size and symptoms.

FAQs

Do fibroids go away after menopause?

They often shrink and become less symptomatic, but may not disappear entirely. Some calcify and remain stable.

Can a fibroid rupture and cause internal bleeding?

Spontaneous rupture leading to significant internal bleeding is extremely rare but has been reported, usually as isolated case reports. Sudden severe pain or signs of shock need urgent care.

Is any bleeding after menopause normal?

No. Any bleeding after 12 months without a period should be evaluated promptly.

Key Takeaways

• “Bursting” fibroids after menopause is rare; more common explanations for acute pain include degeneration or torsion of a pedunculated fibroid.
• Postmenopausal symptoms—especially bleeding or rapid enlargement—need evaluation to rule out other conditions.
• Treatment ranges from observation to UAE, myomectomy, or hysterectomy, tailored to your symptoms and goals.
• If considering surgery, ask about the FDA guidance on power morcellation and alternatives.

Trusted Sources and Further Reading

• ACOG. Uterine Fibroids – Patient FAQ: https://www.acog.org/womens-health/faqs/uterine-fibroids
• NIH MedlinePlus. Uterine Fibroids: https://medlineplus.gov/uterinefibroids.html
• NICHD (NIH). What are fibroids?: https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
• Office on Women’s Health (HHS). Uterine Fibroids: https://www.womenshealth.gov/a-z-topics/uterine-fibroids
• FDA Safety Communication – Laparoscopic Power Morcellators: https://www.fda.gov/medical-devices/safety-communications/updated-recommendations-use-laparoscopic-power-morcellation-myomectomy-or-hysterectomy-fda-safety
• Case literature on rare hemoperitoneum from fibroid vessel rupture (NIH/NCBI PMC): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC

If you’re experiencing new pelvic symptoms after menopause, a prompt conversation with your clinician can clarify the cause and guide a safe, effective plan tailored to you.