I have fibroids. Can I take HRT?

I have fibroids. Can I take HRT?

Fibroids (Q 23.14) may be present in up to 50% of women although most are small and of no clinical significance. All fibroids are initially small but a few can grow to be quite large (exceptionally reaching the size of a large melon). At one time, the only way that we could diagnose fibroids, other than at surgery, was to feel enlargement and irregularity of the uterus during pelvic examination. Unless you are less than average weight, it is unlikely that your doctor would be aware of a fibroid during examination if it is smaller than four centimetres.

Ultrasound has revolutionised our ability to diagnose fibroids. It would seem that about 50% of women having ultrasound have evidence of small fibroids and most of these would not have been detected by routine clinical examination. These small fibroids should not be considered as reason to withhold HRT.

We have been rather cautious about prescribing HRT when there are larger fibroids. We know that fibroids tend to shrink after the menopause suggesting a hormone link. There are times when gynaecologists temporarily suppress oestrogen to menopausal levels. An example would be before removing a large fibroid. The temporary reduction of oestrogen reduces the size of the fibroid and simplifies surgery. This temporary suppression of oestrogen may be for several months and many younger women find this difficult to cope with. In these circumstances, we would also provide HRT (add-back therapy) to control the oestrogen deficiency symptoms: this does not adversely affect the fibroids probably because the amount of hormone in the HRT is less than that in natural cycles. This suggests that our previous anxiety about HRT with regard to fibroids was overstated.

If you have fibroids, you can take HRT but the size of the fibroids should be monitored regularly.  

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