From the Guidelines
Yes, fibroids can cause postmenopausal bleeding, and it is crucial to rule out more serious conditions like endometrial cancer or uterine sarcoma before attributing the bleeding to fibroids. Uterine fibroids, which are benign muscle tumors of the uterus, may occasionally trigger bleeding in women who have gone through menopause, as noted in the 2024 study by the Journal of the American College of Radiology 1. While fibroids typically shrink after menopause due to decreased estrogen levels, some fibroids can still cause bleeding, especially if the woman is taking hormone replacement therapy which can stimulate fibroid growth.
Key Considerations
- Any postmenopausal bleeding requires immediate medical evaluation to determine the exact cause, which may include a pelvic ultrasound, endometrial biopsy, or hysteroscopy 1.
- The bleeding occurs because fibroids can distort the uterine cavity or cause changes to the endometrial lining, leading to irregular shedding and bleeding.
- Treatment options depend on the size and location of fibroids and may include watchful waiting, medications to shrink fibroids, such as tranexamic acid or GnRH agonists, or surgical procedures like hysteroscopic myomectomy if necessary 1.
- It's essential to consider the risk of uterine malignancy in postmenopausal patients with abnormal uterine bleeding, and all such patients should undergo workup to rule out endometrial cancer prior to proceeding with any treatment for fibroids 1.
Treatment Approaches
- Medical management includes anti-inflammatory medications, estrogen-progestin oral contraceptive pills, progestin-containing intrauterine devices (IUDs), and medications that suppress the reproductive axis to decrease symptoms associated with fibroids 1.
- Surgical options, such as hysteroscopic myomectomy, may be helpful in postmenopausal patients with symptomatic fibroids and negative endometrial biopsy when fibroids are submucosal and associated with postmenopausal bleeding 1.
From the Research
Uterine Leiomyomas and Postmenopausal Bleeding
- Uterine leiomyomas, also known as fibroids, are benign tumors that can cause various symptoms, including abnormal uterine bleeding, pelvic pressure, and bowel dysfunction 2, 3.
- While fibroids are most prevalent in women of reproductive age, they can also occur in postmenopausal women 2, 3.
- Postmenopausal bleeding is defined as bleeding that occurs 12 months or more after the last menstrual period, and it can have various causes, including endometrial cancer, cervical cancer, and vaginal atrophy 4, 5.
- Fibroids can cause postmenopausal bleeding, although this is not a common symptom 2, 6.
- A study found that benign pathology, including endometrial atrophy and hyperplasia, was more frequent than malignancy as a cause of postmenopausal uterine bleeding 5.
- However, another study noted that postmenopausal women presenting with enlarging fibroids or vaginal bleeding should be referred for further evaluation, as these symptoms can be suspicious of leiomyosarcoma or other cancers 2.
Diagnosis and Evaluation
- The diagnosis of postmenopausal bleeding involves taking a detailed history, performing abdominal and pelvic examinations, and conducting speculum examination to identify the source of bleeding 4.
- Ultrasound scan and endometrial biopsy are complementary tests used to evaluate postmenopausal bleeding, with the goal of identifying the cause and excluding cancer 4, 5.
- The measurement of endometrial thickness can help identify women with postmenopausal bleeding who are at significant risk of endometrial cancer 4.
Management
- Management of postmenopausal bleeding depends on the underlying cause, and it may involve medical or surgical treatment 3, 4.
- For women with fibroids, management should be tailored to the size and location of the fibroids, as well as the patient's age, symptoms, and desire to maintain fertility 2, 3.