Understanding Uterine Fibroids: What Every Woman Should Know Part 2

Part 2: Menopause Hormone Therapy and Fibroids

If you're approaching or in menopause and have a history of fibroids, you may wonder whether menopause hormone therapy (MHT)—formerly called hormone replacement therapy—is safe for you.

Here’s the nuanced truth:

The Relationship Between Hormones and Fibroids

• Fibroids are estrogen- and progesterone-sensitive, meaning they often shrink after menopause due to the natural decline in these hormones.

• When MHT is introduced—especially estrogen therapy without progesterone—there’s a theoretical risk that fibroids could regrow or become symptomatic again.

• Combined estrogen-progestogen therapy (EPT) is typically used for women with a uterus to protect against endometrial hyperplasia. However, progestogens may also stimulate fibroid growth in some individuals.

What the Research Shows

• Low-dose MHT, especially transdermal estrogen combined with micronized progesterone, has not been consistently shown to significantly increase fibroid size in most women.

• Some women may experience spotting or breakthrough bleeding, especially early in therapy, which may warrant follow-up imaging to monitor fibroid size.

Best Practices for MHT in Women with Fibroid History

If you're considering MHT and have a personal history of fibroids, here are a few important guidelines:

1. Individualized Risk Assessment

   • Your provider should evaluate your fibroid history (size, location, symptoms) and overall health goals before starting MHT.

2. Use the Lowest Effective Dose

   • This reduces the risk of stimulating fibroid growth while still offering symptom relief (hot flashes, sleep disturbances, vaginal dryness, etc.).

3. Transdermal Estrogen Preferred

   • Patches, gels, or sprays are associated with lower systemic hormone levels and a lower risk of fibroid stimulation compared to oral estrogen.

4. Micronized Progesterone is Often Better Tolerated

   • Bioidentical progesterone (e.g., Prometrium®) may have a more favorable profile for fibroid stability compared to older synthetic progestins.

5. Consider a Levonorgestrel IUD

   • For women with uterine fibroids who are good candidates, a hormonal IUD may provide endometrial protection and local progestin delivery, potentially minimizing fibroid stimulation.

6. Monitor with Imaging if Needed

   • If you’ve had symptomatic fibroids in the past or notice new bleeding, your clinician may recommend periodic pelvic ultrasounds to track changes in fibroid size.

7. Discontinue MHT If Fibroids Become Problematic Again

   • In some cases, if fibroid-related bleeding or pressure symptoms return, MHT may need to be adjusted or stopped.

Bottom Line

Menopause hormone therapy is not off the table for women with a history of fibroids, but it requires careful, individualized planning.

In many cases, the benefits of symptom relief and bone, brain, and cardiovascular health outweigh the theoretical risks. Here at Monarch Health, we can assist you in weighing your options and monitoring for any changes.

Thanks for reading!

Dr. Jackie Piasta, DNP