Post Menopause Fibroids Growing and Fibroids: What to Know

September 13, 2025

Post‑Menopause Fibroids Growing: What to Know

Uterine fibroids are common benign growths of the uterus. They usually shrink after menopause as estrogen and progesterone levels fall. But some people notice new symptoms or are told their fibroids look larger, even years after their periods stop. Here’s what’s typical, what’s not, and how to approach evaluation and treatment with trustworthy, evidence‑based guidance.

Do Fibroids Usually Grow After Menopause?

In most cases, fibroids stabilize or shrink after menopause. The National Institutes of Health (NIH) notes that fibroids depend on ovarian hormones, and their growth commonly slows with declining hormone levels (NIH/NICHD). If a fibroid seems to grow after menopause, it warrants a closer look to confirm what’s changing and why.

Why Might a Fibroid Appear to Grow Post‑Menopause?

Body fat and estrogen production: After menopause, the body still makes small amounts of estrogen in fat tissue. Higher body mass index is linked to continued fibroid presence and, in some cases, growth.
Hormone therapy (HRT): Some estrogen‑containing regimens can stimulate fibroids. If you take menopausal hormone therapy, your clinician may monitor fibroid size and adjust dose or formulation to the lowest effective amount.
Natural variation and measurement differences: Ultrasound measurements can vary between exams or technicians. What looks like growth may be within the margin of measurement error.
Degeneration or calcification: Post‑menopausal fibroids often calcify, which can change their appearance and texture on imaging without true growth.
Another diagnosis: Not all pelvic masses are fibroids. Ovarian cysts, polyps, or rare uterine cancers can mimic fibroids. New or enlarging uterine masses after menopause need evaluation to confirm the diagnosis (ACOG).

Symptoms That Deserve Prompt Attention

Any postmenopausal bleeding (even light spotting) is abnormal and should be evaluated. Other symptoms that warrant timely care include:

New or worsening pelvic pressure, pain, or a sense of fullness
Bloating or a visible increase in abdominal size
Urinary frequency/urgency or constipation from pressure effects
Pain with intercourse

While fibroids are benign, these symptoms overlap with conditions that should be ruled out in postmenopause, including endometrial hyperplasia, polyps, and—rarely—uterine sarcoma.

How Clinicians Evaluate Post‑Menopausal Fibroids

Your clinician will review your history (including family history, prior surgeries, and any use of hormone therapy), perform a pelvic exam, and recommend imaging. Common steps include:

Transvaginal ultrasound: First‑line test to confirm the presence, number, and size of fibroids and to assess the lining of the uterus.
Pelvic MRI: Helpful if ultrasound is inconclusive or if surgical planning is needed. MRI better characterizes tissue type and can distinguish fibroids from other masses.
Endometrial sampling: If there is any postmenopausal bleeding or a thickened endometrium, a biopsy is recommended to rule out precancer or cancer (ACOG).

Could It Be Cancer?

Uterine fibroids are benign tumors of smooth muscle. Uterine sarcomas (including leiomyosarcoma) are rare, but they occur more often with increasing age. Because imaging cannot reliably distinguish every benign fibroid from a sarcoma, new or growing uterine masses after menopause require careful assessment. The U.S. Food and Drug Administration (FDA) has specifically warned against using power morcellation during surgery for presumed fibroids in peri‑ and postmenopausal women because it can spread an unsuspected cancer if present (FDA Safety Communication). Your surgeon can discuss techniques that avoid this risk.

Management Options After Menopause

Treatment is individualized and guided by symptoms, fibroid size/location, overall health, and personal preferences.

Watchful Waiting

If you have no symptoms and imaging is reassuring, observation with periodic exams or imaging (for example, in 6–12 months) is reasonable. Many postmenopausal fibroids remain stable or slowly regress.

Medication

Menopausal hormone therapy (MHT/HRT): If you use HRT for hot flashes or other menopausal symptoms and have fibroids, your clinician may choose the lowest effective dose and monitor size. Some people may need adjustments or nonhormonal alternatives if fibroids grow or bleeding occurs.
Nonhormonal options for symptoms: If bleeding occurs (which is abnormal after menopause and must be evaluated first), short‑term nonhormonal treatments may be considered case‑by‑case. However, most medications commonly used for fibroids are intended for premenopausal heavy bleeding and are not standard in postmenopause.

Procedures

Uterine artery embolization (UAE): A minimally invasive radiology procedure that shrinks fibroids by blocking their blood supply. It can be considered in select symptomatic patients who wish to avoid surgery. Suitability depends on fibroid size, number, and overall health.
Hysterectomy: Surgical removal of the uterus is definitive and eliminates fibroid‑related symptoms and the small risk of an occult uterine cancer. It is often favored for significant symptoms in postmenopause, especially when childbearing is complete.
Myomectomy: Surgical removal of fibroids while preserving the uterus. Less commonly chosen after menopause but may be considered for focal symptoms. Your surgeon will avoid techniques that could spread tissue within the abdomen, consistent with FDA guidance.

Hormone Therapy and Fibroids: Practical Considerations

For people who benefit from HRT, the presence of fibroids does not automatically rule it out, but it does warrant individualized planning and monitoring:

Use the lowest effective dose for the shortest duration needed to manage symptoms.
Report any bleeding immediately; it should be evaluated with exam, imaging, and often endometrial sampling.
Follow-up imaging can help ensure fibroids are stable while on therapy.

Discuss nonhormonal options for vasomotor symptoms if fibroids are enlarging or bleeding recurs despite evaluation.

When to See a Clinician

Any bleeding after 12 months without a period
New or worsening pelvic pain, pressure, or bloating
Rapidly increasing abdominal girth
New urinary or bowel symptoms from pelvic pressure
If you are starting, stopping, or changing HRT and have a history of fibroids

Key Takeaways

Most fibroids shrink after menopause, but some persist. Apparent growth should be evaluated to confirm the diagnosis and rule out other causes.
Postmenopausal bleeding is never “normal” and warrants timely assessment.
Imaging (ultrasound, sometimes MRI) and, when indicated, endometrial sampling provide critical information.
Treatment ranges from watchful waiting to procedures like UAE or hysterectomy, guided by symptoms and patient goals.
Hormone therapy can influence fibroids; use individualized, lowest‑effective doses with monitoring.

Trusted Resources

NIH/NICHD: Uterine Fibroids Overview — https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/fibroids
ACOG: Uterine Fibroids Patient FAQ — https://www.acog.org/womens-health/faqs/uterine-fibroids
FDA Safety Communication on Power Morcellation — https://www.fda.gov/medical-devices/safety-communications/updated-laparoscopic-power-morcellation-tissue-containment-systems-when-in-appropriate-fda-safety

This article is for general education and does not replace medical advice. If you have symptoms or concerns about fibroids after menopause, consult a qualified healthcare professional.