Many of my patients are surprised to learn how closely their fibroids follow their hormones. Estrogen and fibroids are tightly linked. Estrogen, along with progesterone, helps fibroids grow during the reproductive years. When those hormones drop after menopause, fibroids usually shrink. Understanding this connection can help explain your symptoms, why your fibroids may change over time, and why some treatments work the way they do.
Key Takeaways
- Estrogen and progesterone both help fibroids grow, which is why fibroids are most common during the reproductive years.
- Fibroids often grow during pregnancy, when hormone levels are high, and usually shrink after menopause.
- Body weight affects estrogen levels, so a healthy weight is one factor you can influence.
- Hormone medicines can ease symptoms, but they do not make fibroids disappear.
- Uterine fibroid embolization (UFE) treats fibroids by cutting off their blood supply, not by changing your hormones.
What Are Uterine Fibroids?
Uterine fibroids are non-cancerous growths in the muscle wall of the uterus. Doctors also call them leiomyomas or myomas. Some are tiny, while others grow large enough to change the shape of the uterus. Many cause no symptoms. Others lead to heavy periods, pelvic pain, pressure, or frequent urination. For a full overview, see my guide to uterine myoma (uterine fibroids).
How Estrogen and Fibroids Are Connected
No one knows exactly what causes fibroids. However, we do know they respond to hormones. According to the American College of Obstetricians and Gynecologists, estrogen and progesterone appear to be involved in fibroid growth.
Here is a simple way to think about it. Fibroid cells have "receptors" for these hormones, a bit like locks that the hormones fit into. When estrogen attaches to those receptors, it signals the cells to grow and divide. Research suggests fibroid tissue is often more sensitive to these hormones than normal uterine muscle. As a result, fibroids can grow when hormone levels are high.
Progesterone Plays a Role, Too
For a long time, estrogen got most of the attention. Today, researchers understand that progesterone also helps fibroids grow. In other words, both hormones work together. That is one reason why some medicines aim to lower or block both of them.
How Fibroids Change Through Life
Because fibroids depend on hormones, they tend to follow the stages of a woman's life.
- Before the first period: Fibroids are very rare.
- Reproductive years: This is when fibroids most often appear and grow, especially in the 30s and 40s.
- Pregnancy: Fibroids may grow because of higher estrogen levels and increased blood flow, according to MedlinePlus.
- Perimenopause: Hormone levels swing up and down, and some women notice symptoms change for a while.
- After menopause: Estrogen drops, and fibroids usually shrink and cause fewer symptoms.
For this reason, if you are close to menopause and your symptoms are mild, watchful waiting may be a reasonable choice. On the other hand, if a fibroid grows after menopause, your doctor should always check it.
Estrogen and Your Monthly Cycle
The link between estrogen and fibroids also shows up month to month. Many women find their fibroid symptoms are worse around their period. Bleeding may be heavier, and cramps or pressure may increase. Tracking your symptoms through your cycle can help you and your doctor spot patterns. Keep a simple log of how heavy your bleeding is, how many days it lasts, and when pain is worst.
Factors That Affect Estrogen Levels
Some things that influence estrogen are within your control. Others are not.
- Body weight. Fat tissue makes estrogen. That is why higher body weight is linked to a higher risk of fibroids.
- Physical activity. Regular exercise supports a healthy weight and overall health.
- Diet. Diets with more fruits and vegetables and less red meat have been linked to lower fibroid risk.
- Family history and race. You cannot change these. However, knowing about them can encourage earlier checkups.
Healthy habits are worth it for many reasons. Still, no diet or supplement has been proven to make fibroids go away.
Hormone Medicines and Fibroids
Because fibroids respond to hormones, many fibroid medicines work by adjusting them. Your gynecologist usually prescribes and manages these. Common options include:
- GnRH medicines, which lower estrogen and progesterone for a time. They can shrink fibroids and reduce bleeding. However, side effects such as hot flashes and bone loss limit how long you can take them.
- Birth control pills or a hormonal IUD, which can lighten heavy periods. They generally do not shrink fibroids.
- Non-hormone pain relievers, such as ibuprofen, which ease cramps.
These medicines can help a great deal. Even so, symptoms often return once you stop taking them.
Hormone Therapy After Menopause
Questions about estrogen and fibroids often come up again at menopause. Women with fibroids sometimes ask whether hormone therapy is safe for them. ACOG notes that hormone medicines containing estrogen may cause fibroids to grow. This does not mean hormone therapy is off limits. Instead, it means you should talk with your doctor about the type and dose, and report any new bleeding or pressure.
Do Fibroid Treatments Change Your Hormones?
This depends on the treatment.
- Hysterectomy ends periods. If the ovaries are also removed before menopause, menopause begins right away, along with its symptoms.
- Myomectomy removes fibroids but leaves the uterus and ovaries, so your natural hormones continue.
- Uterine fibroid embolization leaves the uterus and ovaries in place. Your hormones continue as before in most women. However, RadiologyInfo.org notes that about one to five percent of patients go into menopause after UFE, most often those already close to it.
How UFE Treats Hormone-Driven Fibroids
Hormones help fibroids grow, but fibroids also need a strong blood supply. Uterine fibroid embolization targets that blood supply instead of your hormones. As an interventional radiologist, I guide a thin catheter through a tiny puncture in the wrist or groin to the arteries that feed the fibroids. Then I block those arteries with tiny particles, and the fibroids shrink over the following months.
UFE is not right for everyone. Because its effect on fertility is not fully understood, women who want to get pregnant are often better served by myomectomy. I always coordinate with your gynecologist. To compare all of your choices, read my guide to fibroid treatment options.
Personal Care for Fibroids
Coastal Vascular Center is a small, physician-owned practice, not a corporate chain. You will see me at every visit, and I personally perform every procedure. If you are curious about the first appointment, read what to expect at a UFE consultation.
Get Answers About Your Fibroids With Dr. Ayar
If heavy periods, pain, or pressure from fibroids are affecting your life, an evaluation can help you understand why and what to do next. Dr. Ayar will review your imaging and explain every option, including whether UFE fits your goals. You will see Dr. Ayar at every visit in Pearland or Lake Jackson.
