Would a 5 cm submucosal uterine fibroid cause hormonal or physical symptoms in a postmenopausal woman?

Can a 5 cm Submucosal Uterine Fibroid Cause Symptoms in Postmenopausal Women?

Yes, a 5 cm submucosal uterine fibroid can definitely cause both physical symptoms in a postmenopausal woman, though it does not cause hormonal symptoms. 1

Physical Symptoms That Can Occur

Bleeding Symptoms

• Abnormal uterine bleeding is the most common symptom of submucosal fibroids in postmenopausal women and can persist even after menopause. 1 This is particularly important because submucosal fibroids protrude into the uterine cavity and cause more severe bleeding than other fibroid types. 2

• The bleeding can be significant enough to cause iron deficiency anemia. 2

Bulk-Related Symptoms

• Pelvic pressure, urinary frequency, and constipation may occur due to the size and location of a 5 cm fibroid. 1 These pressure symptoms are common with fibroids of this size. 3

• Urinary frequency is particularly common, occurring in approximately 78% of postmenopausal women with symptomatic fibroids. 4

• The patient may experience increasing abdominal girth or a palpable pelvic mass. 5

Important Clinical Caveat: Rule Out Malignancy

A critical pitfall to avoid: fibroids typically shrink after menopause due to decreased estrogen levels, so any persistent or growing fibroid in a postmenopausal woman is suspicious and requires evaluation for malignancy. 1

• Endometrial biopsy is essential in postmenopausal women with fibroids and abnormal bleeding to rule out endometrial cancer or uterine sarcoma before proceeding with treatment. 1

• Leiomyosarcoma should be suspected in postmenopausal women with fibroid growth, especially if not on concurrent hormone replacement therapy. 6

• Sarcomatous change within fibroids is rare but is normally associated with rapid growth and warrants urgent referral. 5

Hormonal Symptoms: Not Applicable

Fibroids themselves do not produce hormones and therefore do not cause hormonal symptoms. They are estrogen-responsive tumors but do not secrete hormones that would cause systemic hormonal effects. 3 Any hormonal symptoms in a postmenopausal woman with a fibroid would be unrelated to the fibroid itself.

Diagnostic Approach

• Transvaginal ultrasound is the preferred initial imaging modality to confirm size, location, and characteristics. 1

• MRI provides more detailed evaluation if needed, particularly for treatment planning. 1

• Contrast-enhanced MRI can help assess fibroid viability and rule out malignancy. 4