This is a question I get asked a lot, especially from women in their 40s and 50s who are suddenly dealing with heavy periods, bloating, pelvic pressure, or that “why do I look six months pregnant?” feeling. And quite often, they’re trying to work out whether it’s perimenopause, fibroids or both.
Fibroids are really common. They’re non-cancerous growths in or around the womb and, in many cases, they’ve actually been there for years without causing any trouble at all. It’s often the hormone changes in perimenopause that seem to wake everything up.
So the big question is:
Will they shrink after menopause?
For many women they do. Fibroids are influenced by oestrogen, so when oestrogen levels naturally drop after menopause, fibroids often shrink and symptoms settle down. But, it doesn’t happen in the same way for everyone. Some women find everything improves. Others are left still dealing with symptoms even after their periods have stopped.
What do fibroids actually feel like?
They often feel similar to perimenopause symptoms.
Women often describe:
- really heavy or long periods
- a constant feeling of pressure in the pelvis
- bloating that doesn’t seem to go away
- needing the toilet more often
- lower back ache
- painful sex
- fatigue from blood loss
And because perimenopause can also cause changes in bleeding and bloating, it’s really easy to assume it’s just hormones, when actually fibroids might be an issue too
What HRT make fibroids worse?
There is a lot of worry that HRT will make fibroids grow.
Because fibroids can be sensitive to oestrogen, some women may notice a small change in size when starting HRT, but many don’t notice any real difference at all. Most importantly, having fibroids doesn’t automatically mean you can’t take HRT. For many women, HRT is life changing for symptoms like hot flushes, anxiety, sleep problems and mood changes, and that needs to be weighed up alongside everything else.
If you have fibroids, a GP or menopause specialist will usually just keep an eye on symptoms and adjust treatment if needed.
Can progesterone help?
Progesterone doesn’t shrink fibroids, but it can help with one of the biggest issues they cause, bleeding. It works by protecting the lining of the womb and can help to calm heavy periods. Some women notice their bleeding becomes much more manageable once the progesterone part of HRT is right for them. Others need a bit of trial and adjustment to get the balance right. This is very individual, and there isn’t a one-size fits all approach.
Treatment options
What’s offered really depends on your symptoms and how much fibroids are affecting your day to day life.
Options can include:
- medication to help control heavy bleeding
- hormonal treatments
- procedures to reduce blood supply to fibroids
- surgery in more persistent cases
- or sometimes just monitoring if symptoms are mild
When to get checked
I always say, don’t assume heavy bleeding, bloating or pressure is just part of getting older or “normal menopause”. If something feels different for you, or it’s affecting your quality of life, it’s worth speaking to your GP. You don’t need to wait until things are severe.
Final thought
So many women are walking around with symptoms they’ve normalised for years.
Fibroids are common, they’re usually manageable, and for many women they do improve after menopause, but you don’t have to just wait it out if it’s affecting how you feel now.
There is support, and there are options.
Trusted UK resources
- https://www.nhs.uk/conditions/fibroids/
- https://www.nhs.uk/conditions/fibroids/treatment/
- https://www.nice.org.uk/guidance
- https://www.rcog.org.uk/for-the-public/browse-our-patient-information/fibroids/
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