Effects of Menopausal Hormone Therapy on Uterine Fibroids in Women During Menopausal Transition

Uterine fibroids are highly prevalent globally. However, evidence on the effects of menopausal hormone therapy (MHT) on fibroid growth during menopausal transition remains limited. This study explores the association between MHT and the size of uterine fibroids in women during the menopausal transition.

This retrospective observational study enrolled women during menopausal transition with uterine fibroids who received sequential menopausal hormone therapy (estradiol combined with dydrogesterone) at Nanjing Women and Children's Healthcare Hospital from January 2016 to August 2023. Serial ultrasound examinations were performed to dynamically monitor changes in fibroid cross-sectional area during follow-up. A linear mixed-effects model was applied to explore the long-term impact of menopausal hormone therapy on fibroid size alterations over time. Furthermore, all adverse events occurring during hormone therapy were systematically recorded and summarized.

A total of 83 patients were enrolled, with a maximum follow-up of 5 years post-treatment. Although statistically significant differences from baseline in fibroid cross-sectional area were observed during the first four years of follow-up, these changes were marginal and clinically unremarkable and undetectable at year 5. Most adverse events were transient and resolved spontaneously. The incidence rates of unexpected bleeding, breast discomfort and gastrointestinal symptoms were 18.07%, 10.84% and 2.41%, respectively.

Findings suggest that women during menopausal transition that receiving MHT may experience transient, minor changes in fibroid size. These changes are not considered clinically meaningful, and MHT exhibits an overall favorable safety profile for this group. With regular surveillance and use of the lowest effective dose, MHT represents a safe and practical therapeutic choice. Additional prospective investigations are needed to characterize the long-term dynamic changes of fibroids associated with MHT.