From the Guidelines
It is common for a 60-year-old female to have multiple uterine leiomyomas (fibroids), with studies suggesting that up to 80% of women will develop fibroids by age 50, and many having multiple growths. Fibroids are non-cancerous growths that develop in or around the uterus and tend to develop during a woman's reproductive years when estrogen levels are higher [ 1 ]. By age 60, many women are postmenopausal, which typically leads to shrinking of existing fibroids due to decreased estrogen levels. However, fibroids often remain present even after menopause, especially if they were large beforehand.
Key Considerations
- The natural history of fibroids is shrinkage and symptom resolution with menopause due to decreased circulating estrogen and the cessation of menses [ 1 ].
- For women at age 60 with fibroids, treatment is usually only necessary if they cause symptoms like abnormal bleeding (which would be concerning post-menopause), pelvic pain, or pressure on the bladder or bowel.
- Treatment options include watchful waiting, medications like GnRH agonists for short-term symptom management, or procedures such as uterine artery embolization, focused ultrasound, or surgical options like myomectomy or hysterectomy for severe cases.
- Any postmenopausal bleeding should be evaluated promptly to rule out more serious conditions like endometrial cancer, and an endometrial biopsy should be pursued prior to intervention to rule out endometrial neoplasia and, in some cases, diagnose sarcoma [ 1 ].
Management Approach
- Given the elevated incidence of cancer in postmenopausal patients with fibroids and persistent abnormal uterine bleeding, suspicion for malignancy should be increased, and further evaluation is necessary [ 1 ].
- There is no evidence in favor of any one approach for symptomatic uterine fibroids in postmenopausal patients with a negative endometrial biopsy, and management should be individualized based on patient symptoms and preferences.
From the Research
Prevalence of Uterine Leiomyomas (Fibroids)
- Uterine fibroids are the most common tumors of the female reproductive tract 2, 3, 4
- They are common benign neoplasms, with a higher prevalence in older women and in those of African descent 3
- Many uterine fibroids are asymptomatic and require no intervention, although it is advisable to follow up patients to document stability in size and growth 2
Age and Uterine Fibroids
- The incidence of fibroids peaks in the fifth decade of age 5
- Uterine fibroids are the most common tumors affecting premenopausal women, responsible for bleeding, pain, and reduced quality of life 6
- A 60-year-old female is likely to be postmenopausal, and while the prevalence of uterine fibroids may decrease after menopause, it is still possible for her to have multiple uterine leiomyomas (fibroids) 2, 3
Multiple Uterine Leiomyomas (Fibroids)
- It is not uncommon for women to have multiple uterine fibroids 2, 3, 4
- The choice of treatment depends on the patient's age, the number, size, and location of the fibroids, as well as the patient's desire for subsequent fertility and pregnancy 2, 3, 4
- Treatment options for symptomatic fibroids include pharmacologic, surgical, and radiologically guided interventions 2, 3, 4