From the Guidelines
Yes, fibroids can cause postmenopausal bleeding, but it is crucial to rule out more serious conditions like endometrial cancer or uterine sarcoma before attributing the bleeding to fibroids. Uterine fibroids are benign muscle tumors that can sometimes continue to cause symptoms even after menopause, though they typically shrink during this time due to decreased estrogen levels. When a postmenopausal woman experiences vaginal bleeding, fibroids should be considered as a potential cause, but any postmenopausal bleeding requires prompt medical evaluation to rule out more serious conditions 1. The bleeding occurs when fibroids distort the uterine cavity or affect the endometrial lining. Sometimes, fibroids may undergo degenerative changes or become ulcerated, leading to bleeding.
Diagnosis and Treatment
Diagnosis typically involves a pelvic examination, transvaginal ultrasound, and possibly endometrial biopsy or hysteroscopy. Treatment options depend on the severity of symptoms and may include watchful waiting, hormonal treatments, uterine artery embolization, or surgical interventions like myomectomy or hysterectomy. 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. Medical management includes anti-inflammatory medications, estrogen-progestin oral contraceptive pills, progestin-containing intrauterine devices (IUDs), and medications that work by suppressing the reproductive axis to decrease symptoms associated with fibroids such as bleeding and pain 1.
Key Considerations
- Any postmenopausal bleeding requires prompt medical evaluation to rule out more serious conditions like endometrial cancer or uterine sarcoma.
- Fibroids can cause postmenopausal bleeding, but this symptom should never be assumed to be benign without proper medical investigation.
- Treatment options should be chosen based on the severity of symptoms, patient preferences, and the presence of other health conditions.
- Uterine artery embolization and surgical interventions like myomectomy or hysterectomy may be considered in patients with severe symptoms or when medical management is not effective.
From the Research
Uterine Leiomyomas and Postmenopausal Bleeding
- Uterine leiomyomas (fibroids) are benign tumors that can cause abnormal uterine bleeding (AUB) in premenopausal and postmenopausal women 2, 3.
- Although fibroids often regress in menopause, they can still be present and cause symptoms in postmenopausal women 2.
- Postmenopausal bleeding is a broad symptom that can have various causes, including endometrial cancer, cervical cancer, vaginal atrophy, and hormone-producing ovarian tumors 4, 5.
- Uterine fibroids can cause postmenopausal bleeding, as shown in a case study where an aromatase inhibitor was used to treat uterine bleeding in a postmenopausal woman with leiomyomata 6.
Causes of Postmenopausal Bleeding
- Endometrial cancer is present in around 10% of patients with postmenopausal bleeding 4.
- Benign causes of postmenopausal bleeding include endometrial atrophy, endometrial hyperplasia, and cervical polyps 4, 5.
- Uterine fibroids can cause postmenopausal bleeding, although this is not as common as other causes 6.
Diagnosis and Treatment
- A thorough evaluation is required to diagnose the cause of postmenopausal bleeding, including a detailed history, physical examination, and imaging studies such as ultrasound and endometrial biopsy 4, 5.
- Treatment options for uterine fibroids in postmenopausal women include medical therapy, such as aromatase inhibitors, and surgical options, such as hysterectomy or uterine artery embolization 2, 3, 6.