Quick refresher: What are fibroids?

Fibroids are noncancerous tumors made of smooth muscle and connective tissue. They can be located within the uterine wall, protrude into the cavity, or grow on the outer surface. Size ranges from tiny nodules to large masses that enlarge the uterus. Before menopause, fibroids are fueled in part by estrogen and progesterone, which is why they often grow during reproductive years and pregnancy.

After menopause: Do fibroids shrink?

In most people, yes. After menopause, circulating estrogen and progesterone fall significantly. Because fibroids are hormone-responsive, they typically stop growing and often shrink. Many become less symptomatic, and some calcify (harden), which is usually harmless and may even make them less likely to cause bleeding.

However, not all fibroids behave the same. A few key factors can influence whether they shrink or persist:

• Body weight and aromatization: After menopause, fat tissue converts androgens into estrogen (estrone). Higher body fat can mean higher estrogen levels, which may slow fibroid shrinkage.
• Hormone therapy (HRT/MHT): Systemic estrogen—with or without progestin—can stimulate uterine tissue and may lead to fibroid growth or new symptoms in some people. Many still do well on carefully selected regimens, but monitoring is important.
• Individual biology: Genetics and fibroid characteristics (number, size, location) also play a role.

Symptoms to watch for after menopause

Many postmenopausal fibroids cause no symptoms. When symptoms do occur, they often relate to size and location rather than bleeding. Be alert to:

• Pelvic pressure or fullness, abdominal bloating, or a feeling of “bulk”
• Urinary frequency, urgency, or difficulty emptying if a fibroid presses on the bladder
• Constipation or rectal pressure
• Pain or discomfort, sometimes from degeneration or torsion of a pedunculated fibroid

Any bleeding after menopause (12 months without periods) is abnormal and should be evaluated promptly. While fibroids can contribute to bleeding, postmenopausal bleeding requires assessment to rule out other causes, including endometrial hyperplasia or cancer.

Could a fibroid be cancerous after menopause?

True cancer arising in the uterine muscle (leiomyosarcoma) is rare. It can’t be reliably distinguished from a benign fibroid by imaging alone. Red flags that warrant timely evaluation include rapid uterine enlargement, new or worsening pain, and postmenopausal bleeding. Estimates cited by professional guidelines suggest that an unexpected uterine sarcoma is uncommon among people undergoing surgery for presumed fibroids. Your clinician will consider your age, symptoms, exam, and imaging to tailor next steps.

How fibroids are evaluated after menopause

Evaluation typically includes:

• Medical history and pelvic exam to assess uterine size and tenderness.
• Transvaginal ultrasound as the first-line imaging test to confirm fibroids and characterize size and location.
• MRI if ultrasound is inconclusive or detailed mapping is needed for procedure planning.
• Endometrial sampling (biopsy) if there is any postmenopausal bleeding to rule out endometrial pathology.
• Labs such as blood count if bleeding has occurred (to check for anemia).

Treatment options for postmenopausal fibroids

Because many fibroids shrink and quiet down after menopause, a conservative approach is appropriate for most. Management is individualized based on symptom burden, fibroid size/location, other health conditions, and personal preferences.

1) Watchful waiting

If symptoms are mild or absent, periodic follow-up with your clinician is often all that’s needed. This may include clinical exams and repeat imaging if there are new symptoms or growth concerns.

2) Review of menopausal hormone therapy

If you take hormone therapy for menopausal symptoms, discuss fibroid history with your clinician. Some people notice fibroid-related bleeding or pressure on certain regimens. Strategies may include:

• Using the lowest effective dose for the shortest duration needed for symptom control.
• Ensuring adequate progestin if you have a uterus and take systemic estrogen (to protect the endometrium).
• Considering nonhormonal options for hot flashes if fibroids are problematic.

3) Medications for specific symptoms

Medicines have a limited role in truly postmenopausal fibroids, since cycles have stopped. Short-term analgesics may help pain. If bleeding occurs, it must be evaluated first; treatment depends on the cause and may include local or surgical measures.

4) Minimally invasive procedures

• Uterine artery embolization (UAE): Cuts off blood supply to fibroids, shrinking them and reducing bulk symptoms. Typically performed by interventional radiologists and often outpatient.
• MRI-guided focused ultrasound or radiofrequency ablation: Heat-based therapies that can reduce selected fibroids. Availability and candidacy vary.

5) Surgery

• Hysterectomy: Definitive treatment that removes the uterus and eliminates fibroid-related symptoms. Considered when symptoms are significant, when there’s suspicion for malignancy, or when other treatments are unsuitable or ineffective.
• Myomectomy: Removal of fibroids while preserving the uterus. Less commonly needed after menopause but may be considered for select bulk symptoms.

Your care team will weigh benefits and risks, including surgical risks and overall health status, to tailor the choice that fits your goals.

Living well after menopause with a history of fibroids

• Maintain a healthy weight: Weight management may reduce peripheral estrogen production after menopause and could help minimize fibroid persistence.
• Stay active: Regular physical activity supports overall pelvic and cardiovascular health.
• Keep up with routine care: Schedule recommended screenings and see your clinician promptly for new pelvic symptoms or any bleeding.
• Know your options: If fibroids still cause problems, ask about the full range of therapies—conservative, minimally invasive, and surgical.

When to call your clinician

• Any bleeding after menopause
• Rapidly increasing pelvic or abdominal size
• New or worsening pelvic pain, pressure, constipation, or urinary symptoms
• Unexplained fatigue, dizziness, or signs of anemia

Key takeaways

• Most fibroids shrink after menopause as hormone levels fall.
• Some may persist or become symptomatic, especially with higher body fat or on systemic hormone therapy.
• Postmenopausal bleeding is never “normal” and should be evaluated.
• Management ranges from watchful waiting to minimally invasive procedures or surgery, depending on symptoms and goals.

Reliable resources

Learn more from these trusted sources:

• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): Uterine Fibroids
• MedlinePlus (NIH/NLM): Uterine Fibroids
• American College of Obstetricians and Gynecologists (ACOG): Uterine Fibroids
• U.S. FDA: Menopausal Hormone Therapy Information
• National Cancer Institute: Uterine Sarcoma—Patient Version

This article is for general information and does not replace individualized medical advice. If you have symptoms or concerns, consult a qualified healthcare professional.