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Uterine Leiomyomas Across the Menopausal Transition
Diana Encalada-Soto1, Lauri Silver Hochberg, Shannon Laughlin-Tommaso
1Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, and the Division of Gynecologic Imaging, Department of Obstetrics and Gynecology, University of South Florida/Morsani College of Medicine, Tampa, Florida; and the Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Obstetrics and Gynecology
|June 4, 2026
Summary
Uterine leiomyomas (fibroids) are common in midlife women and do not always regress after menopause. Management of fibroids should be individualized based on symptoms, patient factors, and diagnostic uncertainty.
Area of Science:
- Gynecology
- Reproductive Medicine
- Oncology
Background:
- Uterine leiomyomas (fibroids) are highly prevalent by midlife, exhibiting racial disparities in onset and burden.
- Postmenopausal regression of fibroids is variable; some persist or grow, challenging traditional expectations.
Purpose of the Study:
- To guide the evaluation and management of uterine leiomyomas during the menopausal transition.
- To address persistent fibroid growth and symptoms in perimenopausal and postmenopausal women.
Main Methods:
- A structured, nonsystematic literature review using PubMed and Embase.
- Supplementation with guideline and reference reviews for comprehensive analysis.
Main Results:
- Abnormal uterine bleeding and pelvic pain in perimenopausal/postmenopausal women necessitate exclusion of other pathologies.
- Transvaginal ultrasonography is foundational; MRI is adjunctive for indeterminate findings.
- No imaging reliably differentiates leiomyoma from leiomyosarcoma; malignancy risk increases with age.
Conclusions:
- Individualized, symptom-driven management of fibroids is crucial.
- Expectant management for asymptomatic cases; intervention for refractory symptoms or diagnostic uncertainty.
- Consider patient age, comorbidities, hormonal exposures, imaging, and preferences in treatment decisions.
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