Health news blog

Sophie, in her mid-50s, came to see me because her menopausal symptoms were out of control. She had fibroids, and had heard that estrogen often caused fibroids to increase in size, so she hadn’t wanted to take hormone replacement therapy. But she was having a rough time of it without supplemental hormones, so we discussed her options. I explained that fibroids would not grow with the over-the-counter phytoestrogen ipriflavone; or the natural progesterone cream sometimes recommended to combat menopausal symptoms; or testosterone, which sometimes relieves menopausal symptoms; or Evista, the newest drug being sold to treat osteoporosis, which had many estrogen-like properties. My belief is that fibroids are unlikely to grow with estriol and estrone, either, though I haven’t seen any official studies on the matter as yet. Many of my patients with fibroids, or heavy uterine bleeding at menopause, or on Premarin, have had success by changing the type or form of estrogen they use, so I suggested that option to Sophie as well. I encouraged her to look for a way to balance her hormones that would relieve her symptoms and protect her heart and bones, as I was sure we could find one that wouldn’t make her fibroids any worse, though it might take a bit of experimenting to hit on the best one. Finally, I explained that though estradiol (the usual prescription at menopause) is likely to make fibroids grow, not all fibroids are estrogen sensitive, so you could always try it and see, dropping estradiol if you did develop unwanted side effects.

Sophie—a nurse—was most comfortable with the most mainstream option, and decided to try an estrogen patch, with an oral progestin, despite the risk of aggravating her fibroids. She also started taking calcium and vitamin D, and took up a regular program of weight-bearing exercise to protect her bones. She had no side effects from the hormones, including no bleeding (a common sign of large fibroids). I monitored her fibroids via sonogram, which confirmed they did not change in size. And the menopausal symptoms that brought her into my office in the first place also disappeared.

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