Many women in their forties with fibroids causing significant often debilitating symptoms will delay treatment having been told that fibroids shrink after the menopause. This is inaccurate and misleading. After the menopause, assuming that the patient does not have hormone replacement therapy, oestrogen stimulation is removed. Thus fibroids can no longer grow.
Occasionally some fibroids die owing to defective blood supply but this is not common and in most cases fibroid masses will remain relatively unchanged after the menopause. Patients with fibroid masses should therefore be wary of delaying treatment in the hope that fibroid masses may shrink after the menopause.
HRT in the post menopausal woman can cause fibroids to grow or bleed. Post embolisation fibroids are killed and therefore cannot grow or be affected by oestrogen and patients can have HRT after the menopause.
With regard to fertility, statements have been made suggesting that fibroid embolisation causes damage to the normal uterine tissue. Whereas a few cases have been described in the early series in the world literature this complication is extremely rare and may relate to over embolisation or use of the wrong size particles due to inexperience. Particle size is important in embolisation as the diameter of vessels in fibroids is different from that of vessels supplying normal uterine tissue.