Managing Fibroids Adenomyosis Until Menopause

Uterine fibroids are one of the benign tumors most often encountered in the clinic. They are benign lumps that arise in the uterine smooth muscle (the muscular layer of the uterus), and are known as the most common tumors occurring in women of reproductive age. Many people find them incidentally during a checkup, but once they hear "you have a fibroid," they immediately think of surgery and become anxious. However, fibroids and adenomyosis vary greatly in their course depending on size, symptoms, and age, and a considerable number are conditions one can live with, watching them without major problems until menopause. In this article, I will calmly organize the symptoms and course of the two conditions and, above all, how to make the decision patients are most curious about—"watch until menopause, or treat?"

A uterine fibroid is a benign tumor formed as the muscle tissue of the uterus proliferates abnormally. The American College of Obstetricians and Gynecologists (ACOG, 2021) describes fibroids as the most common benign tumors arising in the uterus, and notes that not a few people live without particular symptoms. In other words, the very fact that you have a fibroid does not immediately mean treatment is needed.

Fibroids differ slightly in nature depending on where they arise. They are broadly divided into submucosal fibroids forming under the inner-lining mucosa of the uterus, intramural fibroids settling within the muscle layer, and subserosal fibroids growing outward under the serosa. Because the degree of symptoms differs greatly by location even at the same size, it is hard to judge whether treatment is needed simply by "how many centimeters." In the clinic, it is common for a single small submucosal fibroid to cause heavier bleeding than a large subserosal fibroid.

Looking at domestic statistics too, the number of people treated for uterine fibroids has steadily increased. Data from the Health Insurance Review and Assessment Service also showed an increasing trend in patient numbers over recent years, observed most in those in their 40s. The increase in detection frequency is also partly influenced by the rise in cases where, as checkup accessibility improved, even fibroids that had no symptoms are incidentally found.

The symptoms of fibroids are summed up by the phrase "there may or may not be any." In fact, a considerable number are asymptomatic and found incidentally. However, when symptoms do appear, they cause no small discomfort in daily life, so they are hard to ignore. ACOG (2021) advises considering treatment when there is heavy/prolonged menstruation severe enough to cause anemia or interfere with daily life.

The representative symptoms I often hear in the clinic are as follows.

• When menstrual volume suddenly increases and clots come out mixed in, or the menstrual period grows longer
• When one feels dizzy and easily tired, and anemia is confirmed on testing
• A heavy feeling in the lower abdomen or a sense of pressure as if something is pressing, and pelvic pain
• Pressure symptoms such as frequent urination or constipation as the fibroid presses on the bladder or rectum

Among these, what to watch especially carefully is heavy menstruation accompanied by anemia. When bleeding accumulates, it can lead beyond simple fatigue to dizziness and even shortness of breath, greatly lowering quality of life. If symptoms are at this level, it may be a point requiring active management rather than "watching."

Adenomyosis is a disease in which endometrial tissue burrows into the muscular layer of the uterus, and its starting point differs from that of fibroids. If a fibroid is a relatively distinctly bordered "lump," adenomyosis is closer to a pattern in which the entire uterine wall thickens and hardens. So even for the same uterine disease, the texture of symptoms differs slightly.

Adenomyosis can be asymptomatic, but when symptomatic, it often appears as severe menstrual pain, heavy menstruation, and chronic pelvic pain. In the PALM-COEIN system that classifies the causes of abnormal uterine bleeding, ACOG places adenomyosis as a separate cause item, which means adenomyosis is recognized as one of the important causes of abnormal bleeding.

Ultrasound is primarily used for diagnosis, and when more precise evaluation is needed, magnetic resonance imaging (MRI) is reported to help distinguish adenomyosis from fibroids. If it is hard to judge for yourself where your usual menstrual pain crosses the line, please also look at check points when menstrual pain/irregularity bothers you.

The part many patients are most reassured by is precisely this. Fibroids have the property of growing under the influence of female hormones, so after menopause, when hormone secretion decreases, they generally tend not to grow rapidly anymore and to shrink slowly. ACOG (2021) also, based on the point that fibroids often shrink as one enters menopause, advises that an approach of watching the course can be reasonable for some patients.

So for those with small fibroids and mild symptoms, the closer to menopause, the more "time can be on your side." If you maintain it without major symptoms until menopause, coexisting with the fibroid without difficulty is fully possible even without surgery.

However, "watching" by no means means "leaving it alone." It means active observation—tracking changes in size and symptoms with regular checkups, while confirming whether it grows faster than expected or whether new symptoms arise. In my clinical experience, those who have steadily received checkups more often do not miss the point at which treatment is needed and make more comfortable choices.

If you want to check your overall uterine health, you can set the starting point of regular tracking through the women's life-cycle screening program or a gynecological symptom check. If your symptoms are ambiguous or you hesitate over how to set the checkup interval, the guide on the visit interval for women's disease treatment is also a useful reference.

Conversely, in situations like the following, it is good to shift the weight from "watching" to "treatment" and consult. The criterion for the decision is, after all, not "whether you have a fibroid" but "how much it lowers quality of life."

In particular, when a fibroid grows rapidly in a short period, or rather increases in size after menopause, or is accompanied by abnormal bleeding, you must definitely receive additional evaluation through a specialist's examination. This is because such changes are signals that, even if uncommon, need to be looked at more closely.

Treatment is broadly divided into pharmacological methods and methods that more directly reduce or remove the fibroid. Which method is suitable differs depending on the size, number, and location of the fibroid, as well as the patient's age, symptoms, and whether a pregnancy is planned, so even for the same fibroid, the options recommended differ from person to person.

Pharmacological treatments aimed at relieving symptoms include the following options. Non-steroidal anti-inflammatory drugs (NSAIDs) that reduce pain and bleeding, tranexamic acid that controls heavy menstrual bleeding, combined oral contraceptives, progestin preparations, and GnRH agonists and intrauterine devices that temporarily regulate the hormonal environment are utilized. ACOG (2021) and general recommendations for abnormal uterine bleeding also frequently mention NSAIDs and hormone therapy as first-line management methods.

As methods that more directly try to reduce the fibroid itself than medication, there are uterine artery embolization, radiofrequency ablation, and focused ultrasound, and when symptoms are severe or not controlled by other methods, surgical treatment is also considered. Since the pros and cons, recovery process, and impact on a pregnancy plan differ for any method, sufficient consultation must be a premise. If hormonal changes around menopause are also a concern, you can discuss broadly at menopause hormone treatment, and since costs differ by individual condition, we will guide you after a consultation.

The most important principle in handling fibroids and adenomyosis is that it is not "a single decision" but "steady observation." Since a considerable number of uterine fibroid patients are found incidentally without symptoms, tracking changes in size and symptoms through regular checkups is most important.

In the clinic, "watch or treat" is closer to a process of adjusting together over time than a decision nailed down at one point in time. It is a natural flow to watch today as a fine state, and turn the direction toward treatment if symptoms change a year later. So even if you have received a diagnosis of "you have a fibroid," there is no need to be too hasty. What matters is that tracking continues without a break.

Through a specialist's examination and consultation, observe changes in the size and symptoms of the fibroid and decide together, each time, on the most appropriate method. Whether or not you have symptoms, if your uterine health bothers you, please start with an examination with a light heart.

Written by: Lee Dong-hee, Director · OB-GYN specialist · View doctor profile

First published January 16, 2024 · Last reviewed May 30, 2026

References: American College of Obstetricians and Gynecologists, Management of Symptomatic Uterine Leiomyomas (2021), American College of Obstetricians and Gynecologists, Abnormal Uterine Bleeding PALM-COEIN (2021)

This article is intended to provide general health information and does not replace individual diagnosis or treatment. If you have symptoms, please consult through an examination.