Uterine fibroids mostly occur in the late middle age, and about 20% to 25% of women suffer from uterine fibroids before menopause. What should be done when fibroids develop near menopause? The decision depends on a comprehensive evaluation of the location and size of the fibroids, the severity of symptoms, and the presence of complications. Generally, the following treatment methods can be adopted.
(1) Observation and Follow-up
For perimenopausal women approaching menopause, if fibroids grow slowly, the uterus is smaller than 12 weeks of gestational size, and there are no symptoms such as heavy menstrual bleeding or pressure effects, no active treatment is needed. Follow-up checks every 3 to 6 months are recommended, expecting fibroids to shrink after menopause. After menopause, as estrogen secretion decreases, fibroids lose hormonal stimulation and gradually atrophy. However, women with fibroids often experience late menopause. If fibroids continue to enlarge or new symptoms appear during observation, surgery should be considered.
(2) Western Medicine Treatment
Western medicine can effectively relieve clinical symptoms. For patients with heavy menstrual flow and small fibroids, after excluding endometrial lesions, estrogen-related therapy may be used. Androgens promote contraction of uterine smooth muscle and blood vessels, antagonize estrogen, cause endometrial atrophy, and reduce bleeding. Common androgens include methyltestosterone 5mg orally once or twice daily, or testosterone propionate 25mg intramuscularly two to three times weekly. The total monthly dose of androgens should not exceed 250mg to avoid virilization. Other hemostatics such as ethamsylate, aminocaproic acid, and vitamin K also help reduce bleeding.
(3) Traditional Chinese Medicine Treatment
Traditional Chinese Medicine (TCM) has shown satisfactory effects in treating uterine fibroids, especially in relieving heavy menstrual bleeding and abdominal pain. In clinical practice, a customized TCM formula has been used to treat more than 60 patients. Most achieved significant symptom improvement after three months, and nearly half had obvious fibroid shrinkage. The formula is made into small water pills, taken 9g twice daily, suspended during menstruation, with one course lasting one month. TCM treatment focuses on regulating qi, resolving stagnation, softening hardness, and dissipating masses, helping stabilize the condition without strong hormonal side effects.
(4) Surgical Treatment
Surgery is indicated if any of the following conditions exist: ① The uterus is enlarged beyond 12 weeks of gestational size, even without symptoms. ② Heavy menstrual bleeding leads to anemia and is unresponsive to conservative treatment. ③ The tumor presses on the bladder or rectum, causing frequent urination, dysuria, constipation, or pelvic pain. ④ Fibroids are located in the cervix, broad ligament, or are submucosal. ⑤ Rapid growth of fibroids within a short period.
Surgical methods vary individually. Vaginal myomectomy can be performed for prolapsed submucosal fibroids. Hysteroscopic myomectomy is now widely used for non-prolapsed submucosal fibroids. Endometrial ablation may be applied to induce artificial amenorrhea for heavy bleeding caused by intramural fibroids. Total hysterectomy is the most common procedure for other fibroid types. Subtotal hysterectomy preserving the cervix is optional in poor general health or limited technical conditions. Ovarian preservation depends on age; bilateral oophorectomy is usually performed in postmenopausal women over 50. Hysterectomy is generally safe with few complications and fast recovery. Since menopausal women have no fertility needs, open myomectomy is usually not recommended.