For most women, fibroids shrink after menopause and often stop causing symptoms. Fibroids depend on the hormones your ovaries make, so when those hormone levels fall, fibroids usually get smaller. There are two important exceptions. Any bleeding after menopause needs to be checked by a doctor, and a fibroid that grows after menopause needs a closer look. This guide explains what is normal, what is not, and what your options are if fibroids still bother you.
Why fibroids usually shrink after menopause
Fibroids are noncancerous growths of the muscle wall of the uterus. Their growth is driven largely by estrogen and progesterone. The American College of Obstetricians and Gynecologists (ACOG) notes that fibroids often shrink when a woman enters menopause, and the US Office on Women's Health says they "stop growing or shrink once a woman reaches menopause."
That is a general pattern, not a promise. A 2020 review in the journal Menopause describes the shrinking that begins at menopause as "a generality," because fibroids can still be present and still cause symptoms in this age group. A large fibroid may get smaller without disappearing, so pressure on the bladder or bowel can continue.
The years around menopause
Fibroids are most common in women in their 40s and early 50s, according to the Office on Women's Health. That means many women reach perimenopause, the years leading up to the last period, with fibroids already in place. During perimenopause, cycles often become irregular and periods can be heavier or closer together. Fibroids can add to that.
The same 2020 review points out that abnormal bleeding is the most common way fibroids show up in perimenopause and menopause, but that bleeding is "a broad symptom and may not be specific" to fibroids. In other words, heavier or irregular bleeding at this stage should not be blamed on fibroids until a doctor has looked for other causes, such as changes in the lining of the uterus.
Bleeding after menopause always needs evaluation
Menopause is the point when you have gone 12 months in a row without a period or spotting, according to the National Institute on Aging. After that point, any vaginal bleeding or spotting is not normal and should be checked promptly, even if you know you have fibroids and even if it happens only once.
The reason is not usually fibroids. It is that postmenopausal bleeding is the main early warning sign of cancer of the uterine lining. ACOG has noted that vaginal bleeding is the presenting sign in more than 90% of postmenopausal women with endometrial cancer. Most bleeding after menopause turns out to have a harmless cause, but only an evaluation can tell.
In April 2026, ACOG published updated guidance on how transvaginal ultrasound should be used to evaluate postmenopausal bleeding, revising part of its 2018 advice. If you read older articles that describe a single ultrasound measurement as enough to rule out a problem, know that this guidance has changed. Your gynecologist may recommend an ultrasound, a sample of the uterine lining, or both. The key message has not changed: bleeding after menopause always deserves a visit.
Questions about your treatment options? Dr. Fox can help.
Book a ConsultationThis article is part of our Fibroid Treatment Guide.
A fibroid that grows after menopause
Because fibroids normally shrink after menopause, new growth is unexpected and should be evaluated. Aetna's fibroid treatment policy, for example, lists fibroid growth in postmenopausal women, or rapid growth at any age, as a possible sign of a uterine sarcoma and a reason not to proceed with embolization until that is sorted out.
It helps to keep the risk in proportion. The Office on Women's Health says a cancerous fibroid occurs rarely, in less than one in 1,000 cases. Fibroids themselves do not turn into cancer. But the US Food and Drug Administration has noted that the risk of an unsuspected uterine cancer rises with age, "particularly in women over 50." That is why a growing mass after menopause gets more attention than the same finding at 35. Our article on whether fibroids can be cancer explains this in more detail, and our guide to fibroid imaging covers what ultrasound and MRI can and cannot show.
Hormone therapy and fibroids
Many women consider menopausal hormone therapy for hot flashes, sleep problems or other symptoms. A common question is whether it will make fibroids grow again. The honest answer is that the research is unsettled. The 2020 Menopause review notes that many clinicians worry about regrowth, but that research on this question "remains inconclusive." An older review from 2001 found that fibroids could grow in women taking hormone therapy, but that this growth did not appear to cause symptoms.
If you have fibroids and are thinking about hormone therapy, talk it through with your gynecologist. They can weigh your symptoms, your fibroid history and your other health risks, and may suggest follow-up imaging if your symptoms change.
At a glance: what changes mean after menopause
| What you notice | What it usually means | What to do |
|---|---|---|
| No symptoms; fibroids seen on an old scan | Fibroids are likely shrinking or stable | Routine checkups; no treatment needed for most women |
| Any vaginal bleeding or spotting | Needs a cause found; often harmless, sometimes not | See your gynecologist promptly |
| Ongoing pelvic pressure or frequent urination | A large fibroid may still be pressing on nearby organs | Discuss imaging and options |
| A fibroid that is growing | Unexpected after menopause | Get it evaluated before any treatment decision |
| Sudden, severe pelvic pain | Can have several causes | Seek urgent care |
Do fibroids after menopause need treatment?
Most do not. ACOG's 2021 practice bulletin supports watchful waiting for women whose fibroids cause no symptoms or who do not want treatment. After menopause, that describes many women, because bleeding from fibroids usually stops and the fibroids shrink.
Treatment may still make sense when a fibroid keeps causing bulk symptoms, such as pressure, frequent urination, constipation or a visibly enlarged abdomen, or when a growing fibroid needs a diagnosis. The 2020 review lists several possible approaches for this age group, including surgery, uterine artery embolization and certain medications. The right choice depends on what is causing your symptoms, your overall health and whether cancer has been reasonably ruled out.
Uterine fibroid embolization is mainly studied in women who still have periods, and its main benefits are less bleeding and less bulk. If you are near menopause and weighing it, our article on UFE and early menopause covers how the procedure can affect the ovaries in women over 45. You can learn more about how the procedure works on our uterine fibroid embolization (UFE) page, and compare every option in our fibroid treatment guide.
When to see a doctor
Make an appointment if you have:
- Any bleeding or spotting after menopause, even once
- A fibroid that has grown on a follow-up scan
- New or worsening pelvic pressure, bloating or a growing waistline
- Frequent urination, trouble emptying your bladder, or constipation that is new for you
Seek urgent care for sudden, severe pelvic or abdominal pain, heavy bleeding with dizziness or fainting, or pelvic pain with fever.
Frequently Asked Questions
Do fibroids go away after menopause?
They usually shrink, but they do not always disappear. A large fibroid may get smaller and still press on the bladder or bowel, so some women keep having pressure symptoms.
Is bleeding after menopause caused by fibroids?
It can be, but you should not assume so. Bleeding after menopause is the main warning sign of cancer of the uterine lining, so any bleeding or spotting needs to be evaluated promptly, even if you know you have fibroids.
Can hormone therapy make fibroids grow?
It might. A 2020 review called the research on regrowth inconclusive, and an older review found some growth without new symptoms. Discuss your fibroid history with your gynecologist before starting hormone therapy.
Is a fibroid that grows after menopause cancer?
Usually not, since cancerous fibroids are rare. But growth after menopause is unexpected and the risk of an unsuspected uterine cancer rises with age, so it should be evaluated before any treatment decision.
Can you have UFE after menopause?
UFE is mainly studied in women who still have periods. After menopause, a fibroid that is still causing symptoms or growing first needs a careful evaluation. Your doctor can then discuss whether embolization or another option fits.
Keep Reading
- Uterine Fibroid Embolization (UFE) in New York City
- Can Fibroids Turn Into Cancer? What the Evidence Says
- Will UFE Cause Early Menopause? Ovarian Function and Age
- Fibroid Diagnosis: Ultrasound vs MRI
- Fibroid Size: When Does a Fibroid Need Treatment?
- Fibroid Symptoms: 9 Signs to Know
- Fibroid Treatment Guide: every option, compared
Sources
- American College of Obstetricians and Gynecologists — Uterine Fibroids (patient FAQ, last reviewed December 2025)
- Office on Women's Health, US Department of Health and Human Services — Uterine fibroids (updated February 2025)
- Ulin et al., Menopause, 2020 — Uterine fibroids in menopause and perimenopause
- Ang et al., Climacteric, 2001 — Hormone therapy and SERMs in postmenopausal women with fibroids: a literature review
- ACOG Committee Opinion No. 734, Obstet Gynecol, 2018 — Transvaginal ultrasonography and the endometrium in postmenopausal bleeding
- ACOG Clinical Practice Update, Obstet Gynecol, 2026 — Updated guidance on transvaginal ultrasonography in postmenopausal bleeding
- Aetna Clinical Policy Bulletin 0304 — Fibroid treatment (last review April 2026)
- US FDA safety communication, December 2020 — Perform only contained morcellation when laparoscopic power morcellation is appropriate
- ACOG Practice Bulletin No. 228, Obstet Gynecol, 2021 — Management of symptomatic uterine leiomyomas
- National Institute on Aging — What is menopause?
Medically reviewed by David Fox, MD, FACS, RPVI. This article is general information, not a substitute for a medical evaluation.
Living with heavy periods, pelvic pressure or other fibroid symptoms? Schedule a consultation with Dr. David Fox at Fox Vein & Vascular in Manhattan to find out whether uterine fibroid embolization is right for you. Call (212) 362-3470 or request a UFE consultation online.
