Uterine fibroids are typical estrogen-dependent tumors, meaning their growth and development are closely dependent on estrogen levels in the female body. Understanding the relationship between uterine fibroids and estrogen is crucial for the prevention, monitoring, and treatment of this disease, especially for women of childbearing age and perimenopausal women who are more likely to develop fibroids.
For a healthy woman, excessive estrogen in the body can lead to a series of gynecological problems. For example, uterine fibroids are closely related to high estrogen levels, and polycystic ovary syndrome (PCOS) is also associated with abnormal estrogen levels—though more importantly, it is caused by excessive androgens in the body.
The incidence of uterine fibroids is extremely high: 1 out of every 5 women will develop uterine fibroids at some point in their lives. Taking Beijing as an example, with a population of 20 million, approximately 10 million are women, half of whom are of childbearing age (around 5 million). Based on the 1-in-5 incidence rate, about 1 million women in this group have uterine fibroids. However, only a small number of these patients need to seek medical treatment or undergo surgery. Many patients ask their doctors: "Since fibroids are related to estrogen, can we completely remove estrogen from the body?" Technically, this is feasible—removing estrogen would definitely stop fibroid growth, and existing fibroids would gradually atrophy without estrogen stimulation. However, for a 20-year-old woman, the absence of estrogen would cause severe side effects: changes in skin appearance (such as dryness and atrophy), vaginal dryness, difficulty in sexual intercourse, breast atrophy, and an increased risk of osteoporosis in the future. Although removing estrogen would eliminate fibroids, the severe side effects are unacceptable to almost all patients, so this approach is not recommended in clinical practice.
Some patients also ask: "Why not use drugs to stop ovarian estrogen secretion?" For example, gonadotropin-releasing hormone agonists (GnRH-a), a commonly used type of drug, can inhibit the hypothalamic-pituitary-gonadal axis. After one month of use, patients may experience menopausal symptoms such as hot flashes and vaginal dryness. We believe that using such a treatment that causes significant discomfort to address uterine fibroids is unnecessary, especially for small, asymptomatic fibroids.
Many patients worry: "If we do not treat fibroids related to estrogen, won’t they keep growing?" In fact, this is a possibility, but there is no better alternative. If fibroids grow significantly, surgical treatment will be adopted. Currently, this is the most practical clinical approach—we do not want to use aggressive treatments that cause severe side effects to interfere with fibroids, as not all fibroids will grow or become problematic. Only a small number of fibroids will grow to a size that requires intervention.
As estrogen-dependent tumors, uterine fibroids grow rapidly in high-estrogen environments, such as during pregnancy or when taking estrogen supplements without medical guidance. Supplementing estrogen can indeed help relieve menopausal symptoms in women, but it must be done under the guidance of a doctor. Once symptoms improve, the medication should be stopped immediately. At the same time, regular B-ultrasound examinations are necessary to monitor the growth of uterine fibroids and adjust the treatment plan in a timely manner.
It is worth noting that perimenopausal women are also at risk of uterine fibroid growth, as estrogen levels during this period fluctuate before gradually declining. For perimenopausal patients with uterine fibroids, doctors will usually recommend regular follow-up to monitor fibroid size and symptoms. After menopause, as estrogen levels drop significantly, most fibroids will naturally shrink, so aggressive treatment is generally not required unless the fibroids cause severe symptoms such as heavy bleeding or compression.