HRT & Fibroids

They may cause no symptoms, but they can be associated with heavy and painful periods. Depending upon the location of fibroids, they may also cause pressure symptoms affecting other areas in the abdomen and pelvis, such as urinary symptoms, bloating, back pain, painful sex and constipation. Less commonly, they can interfere with fertility and pregnancy. Because fibroids can cause heavy bleeding, they can lead to anaemia in some people, which – in turn – can lead to other symptoms such as tiredness.

Fibroids grow in different areas of the womb and are given different names based on the location. This is important to know as the location of a fibroid determines the type of symptoms that it may cause.

Subserous fibroids grow on the outside of the womb and are most likely to cause pressure symptoms such as constipation. If they grow on a stalk in this area, they are known as pedunculated fibroids.

Intramural fibroids grow in the muscle layer of the womb and are the most common type; these are more likely to be associated with painful periods. Submucosal fibroids are found in the inner wall of the womb; they can cause heavy periods and can alter the shape of the uterine cavity. This occasionally causes issues with fertility and pregnancies.

Fibroids are usually diagnosed following an examination or pelvic ultrasound scan. They do not necessarily require any treatment unless they cause symptoms or are large.

For people suffering with heavy painful periods due to fibroids, tranexamic acid can be used to reduce the bleeding and anti-inflammatory medication, such as mefenamic acid, can help with period pains. Other options include the contraceptive pills (the combined oral contraceptive pill or progestogen-only pill) which can make periods lighter. The IUS, such as the Mirena ‘coil’, is another option that can lighten or stop periods; however, in some women with submucous fibroids it may be difficult (and sometimes impossible) to insert.

Other treatment options include shrinking or removing the fibroids. This can be achieved using medication or having a procedure. A type of medication known as a GnRH (gonadotrophin releasing hormone) analogue can be given to shrink fibroids. This is usually a monthly injection, although tablets have also now become available, and are given for a maximum of six months.

These medications can trigger menopausal symptoms and side effects related to low oestrogen levels such as thinning of the bones and, therefore, are sometimes given alongside ‘add back’ HRT to reduce the effects of an induced menopause. They can also be used prior to surgery to shrink the fibroids, with the aim of making surgery more straightforward.

Surgical options include removing the womb (hysterectomy) or individual fibroids. Hysterectomy tends to be the preferred surgical option in women who do not want any (more) children, and myomectomy (surgical fibroid removal) is reserved for those women wishing to conserve their fertility. Other options include uterine artery embolization, which is a less invasive procedure cutting off the blood supply to the fibroid and resulting in it shrinking, and endometrial ablation – a procedure to remove the womb (endometrial) lining and reduce bleeding.

Although HRT may increase the size of fibroids, it is still an option for most women who would like to take HRT for perimenopausal, and menopausal, symptoms. Under specialist guidance, it should be possible to find a regime that works well for you and improves your overall health and well-being.