Follow-Up of Asymptomatic Uterine Fibroids After Menopause

Abstract

The development and growth of uterine fibroids are primarily influenced by ovarian estrogen and progesterone. Following menopause, the decline in ovarian steroid hormone production generally induces spontaneous regression of uterine fibroids and improvement of associated symptoms. However, this regression is not necessarily complete, and some fibroids may persist or demonstrate limited reduction in size. For asymptomatic uterine fibroids or adenomyosis, routine imaging examinations, including magnetic resonance imaging (MRI), are generally unnecessary after menopause. However, if new symptoms such as genital bleeding, lower abdominal pain, or abdominal distension develop, prompt re-evaluation is essential to exclude malignant disease. Uterine fibroids are benign mesenchymal tumours that occur in approximately 30% of women over 30 years of age and in 40–50% of women over 40 [1-3]. Although approximately half of affected women are asymptomatic, many undergo periodic clinical surveillance or receive treatment for fibroids. The development and growth of uterine fibroids are strongly influenced by ovarian estrogen and progesterone. Many clinicians are concerned about the management of uterine fibroids after menopause. This article examines the appropriate management and follow-up of uterine fibroids during the menopausal transition and postmenopausal period.