Fibroids in Perimenopause and Menopause: Symptoms, HRT and Treatment Options
Article written by Dr Emma Ginns and Dr Mari Walling, British Menopause Society Registered Specialists and BSLM Lifestyle Medicine Physicians, Co-founders of Lemala Health. June 2026
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
In this guide, we explore the symptoms, diagnosis and treatment of fibroids, how they can affect bleeding patterns and wellbeing during perimenopause and menopause, and what women need to know about using HRT if they have fibroids.
Fibroids are very common and many women will develop them at some point during their lifetime.
For some women, fibroids cause no symptoms at all and are only discovered during a routine scan. For others, they can contribute to heavy periods, pelvic discomfort, bladder symptoms and iron deficiency.
Fibroids often become particularly relevant during perimenopause, when hormonal fluctuations can already cause changes to menstrual bleeding patterns.
Understanding what fibroids are, how they may affect your symptoms, and what treatment options are available can help you make informed decisions about your health.
What are fibroids?
Fibroids are non-cancerous growths that develop from the muscle tissue of the uterus (womb).
They can vary considerably in size, from very small fibroids that cause no symptoms to larger fibroids that may affect the size and shape of the uterus.
A woman may have a single fibroid or several fibroids.
How common are fibroids?
Fibroids are extremely common.
It is estimated that around two in three women will develop fibroids at some point during their lifetime, although many never develop symptoms.
Fibroids are most commonly diagnosed between the ages of 30 and 50 and are frequently identified during the perimenopausal years.
What symptoms can fibroids cause?
Many women with fibroids have no symptoms.
When symptoms do occur, they may include:
Heavy or prolonged menstrual bleeding
Passing blood clots during periods
Painful periods
Pelvic pressure or discomfort
Abdominal bloating or a feeling of fullness
Frequent urination
Constipation
Lower back pain
The symptoms experienced often depend on the size, number and position of the fibroids.
Fibroids and perimenopause
Fibroids and perimenopause commonly occur at the same stage of life.
During perimenopause, hormone levels fluctuate and many women notice changes in their menstrual cycle. Periods may become heavier, lighter, more frequent or less predictable.
Fibroids can also contribute to heavy bleeding and pelvic symptoms, making it difficult to know whether symptoms are being caused by perimenopause, fibroids, or a combination of both.
Heavy periods should not automatically be assumed to be a normal part of perimenopause. Persistent or troublesome bleeding should always be assessed to identify any underlying causes and discuss appropriate treatment options.
You may wish to read our menopause and perimenopause symptom checker.
Fibroids, heavy periods and iron deficiency
One of the most common problems associated with fibroids is heavy menstrual bleeding.
Over time, heavy periods can lead to iron deficiency, with or without anaemia.
Iron deficiency can cause a wide range of symptoms, including:
Fatigue
Poor concentration or brain fog
Breathlessness on exertion
Hair shedding
Reduced exercise tolerance
Restless legs
Many women assume these symptoms are simply part of perimenopause, when in fact iron deficiency may also be contributing.
Blood tests can help identify iron deficiency and guide treatment where appropriate.
Do fibroids shrink after menopause?
Fibroids often become smaller after menopause.
This is thought to occur because levels of oestrogen and progesterone naturally decline after the menopause transition.
However, fibroids do not always disappear completely and some women may continue to experience symptoms.
Can I use HRT if I have fibroids?
Many women with fibroids can use hormone replacement therapy (HRT) safely and effectively.
The decision to use HRT should take into account:
Your individual medical history and preferences
The size and location of the fibroids
Whether fibroids are currently causing symptoms
Presence of menopausal symptoms
For many women, the benefits of treating troublesome menopause symptoms outweigh any concerns relating to fibroids.
In some women, fibroid symptoms may change after starting HRT. If symptoms such as heavy bleeding, pelvic pressure or abdominal discomfort develop or worsen, further assessment may be appropriate.
Treatment decisions should always be individualised and discussed with a healthcare professional.
What treatments are available for fibroids?
Treatment depends on:
The severity of symptoms
The size and location of the fibroids
Your age and stage of life
Whether you are approaching or have reached menopause
Your personal preferences
Possible treatment options include monitoring and medications to help with heavy periods (including hormonal coils).
When symptoms are severe or significantly affecting quality of life, additional treatment options may include surgical procedures including hysterectomy.
If a hysterectomy is performed, some women keep their ovaries while others may have one or both ovaries removed at the same time. Removing the uterus alone does not cause menopause if the ovaries remain. However, removal of both ovaries causes an immediate surgical menopause, which can lead to menopausal symptoms and has important implications for long-term health and treatment decisions, including the possible use of hormone replacement therapy (HRT).
You can learn more about surgical menopause: Symptoms, HRT and longterm health in our full guide.
Can lifestyle changes help?
Lifestyle changes are unlikely to make existing fibroids disappear, but they can play an important role in supporting overall health and wellbeing during perimenopause and menopause.
Regular physical activity, a balanced diet, maintaining a healthy weight and prioritising sleep can all support long-term health.
For women experiencing heavy bleeding, ensuring adequate iron intake and identifying iron deficiency may be particularly important.
When should I seek medical advice?
You should seek medical advice if you experience:
Heavy menstrual bleeding
Bleeding between periods
Symptoms of iron deficiency such as fatigue or breathlessness
Pelvic pain or pressure
A noticeable increase in abdominal size
New or worsening symptoms
Any vaginal bleeding after menopause
These symptoms do not necessarily mean something serious is wrong, but they should be assessed appropriately.
Explore blood testing options with Lemala Health.
Key take-home messages
Fibroids are very common.
Many women with fibroids have no symptoms.
Fibroids can contribute to heavy periods, pelvic pressure and bladder symptoms.
Heavy menstrual bleeding can sometimes lead to iron deficiency and fatigue.
Fibroids often become smaller after menopause.
Many women with fibroids can use HRT.
A range of effective treatment options are available.
At Lemala Health, we regularly support women navigating both perimenopause and menopause alongside conditions such as fibroids. Understanding the whole picture can help ensure that symptoms are properly assessed and that treatment decisions are tailored to your individual needs and preferences.
Further support and information
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