I’m so pleased others have access to this info now! I had a hysterectomy (ovaries not removed) 7 years ago after maybe 5 years of ridiculously heavy bleeding. Dr at the time chalked it up to perimenopause until the bleeding got so obstructive to my life that i got an ultrasound and he found a softball sized fibroid. By the morning of my surgery, my hemoglobin was 6, which explained my obsessive (and shameful to me) ice chewing. I wish I’d advocated for myself better all those years by presenting more clear and accurate descriptions of my issue, because just saying “heavy bleeding” to my Dr likely trivialized the epic bleeding I was enduring. Anyway, glad you’re on this earth!
Thank you for this deep dive, Dr. Gunter. Incredibly timely. I’m 52, post menopausal with 2 new fibroids since I started MHT at age 50. Your article will help me make informed choices moving forward.
Also - I wonder if at some point it’s in you wheelhouse to discuss vaginal atrophy, UTIs linked to that condition, and dryness in menopause. Thank you.
If you go to The Hormone Therapy Guide under section 4 I have six posts about all the different therapies for genitourinary syndrome of menopause and all the treatment options and how to troubleshoot when they are not helping https://vajenda.substack.com/p/gunters-guide-to-the-hormone-menoverse
“Removal of the fibroid, with either a myomectomy or hysterectomy., is also recommended whenever there is a concern about cancer.”
How does a woman know if there is concern about cancer when being diagnosed with fibroids? I’ve seen three different gynecologists in the past year and a half, and I have zero faith that they care if I have cancer or not.
"or for anyone in menopause fibroids that are growing or are causing pai. " That was me for years. They just kept growing and growing despite assurances from my doctor that they would shrink because I had gone through menopause. No one ever mentioned the possibility of cancer. I had no idea that could be a problem.
Thank you for the article. I couldn't comment on it before, because it sent me to a dark place. I had fibroids, for years. Lots of debilitating pain. My doctors kept telling me that they would shrink when I went through menopause, so nothing needed to be done. This went on for years as the fibroids continued to grow and the pain got worse and worse. In 2019 (years after I had supposedly gone through menopause), the doctors finally decided that something needed to be done. I was in so much pain I was now missing work frequently and had difficulty driving. Their decision was that I needed a hysterectomy. Mine was the last elective surgery done right before the pandemic in March 2020. They sent me home the day of the surgery with a catheter in place that I would later have to remove myself. I went from sick leave to working from home. All I got after the surgery was three phone calls - two checking in on me, and one chewing me out for not answering the phone for the second call. (I did and spoke to a someone helping out (trainee? intern? I can't remember) and her report never made it into my record. I mostly feel better, although the surgery caused some additional issues I am trying to get my doctors to take seriously.
Thank you for this brilliant and thorough piece. I had extensive fibroids that resulted in extremely heavy, unpredictable bleeding about six years ago, and ultimately underwent a total hysterectomy as the tissue of my uterus was completely “seeded”/compromised. I was misdiagnosed with perimenopausal bleeding (when I soaked the mattress one night I had a feeling that it was more) and it took months and the right gyn to figure things out! As usual, women need more information and awareness - so thank you so much, you are a blessing to us all!!! ❤️
Great information. Thank you! Can you address whether there is any evidence that women can make lifestyle changes, eg. in their eating/diet that can shrink fibroids? There is anecdotal talk of nutrition and herbal/supplement regimen helping to shrink fibroids but I haven’t been able to find any evidence based concrete information.
Thank you so much for sharing your knowledge, research, takes and information with us, greatly appreciated!
I just turned 50, and I’m experiencing minor symptoms, one is heavy bleedings during still quite regular periods (probable cause for persistent low ferritin levels, effecting iron levels) and the other might be the intensification of existing depression. My question is therefor manyfold and concerns the effect on fibroids (and possibly depression) by treating this bleeding with local hormonal treatment with the Mirena. Prior to placing it my state of depression was elaborately discussed (irt effect of hormones) and an ultrasound was done to explain possible other (than hormonal) causes for abnormal bleedings 3 (relatively small) fibroids were found. My ObGyn placed the Mirena nonetheless, after comforting my immediately expressed concerns. After, I read in the manual the Mirena should not be placed in the presences of fibroids, which I see confirmed in this article, saying that hormones can cause growth of fibroids. Besides the manual states depression as a top side-effect. When consulting my GP for a second opinion —either from my GP or another ObGyn— my concerns were again dismissed, as was my urge to remove the Mirena immediately. “the pros should outweigh the cons”. I am worried for the opposite. I am also confused, as the ObGyn says it might reduce the fibroids. Could you shine your light on the validity of my concerns? And how to read this contradictory information?Depression effect might be a difficult one, as the Mirena hormones act mainly local, but anything about the effect on the fibroids would be very helpful in my journey to advocate for the best care. Thank you so much!! HNY, from the Netherlands.
We place Mirena IUDs with fibroids for the treatment of heavy bleeding, especially in the presence of smaller fibroids. The issue is for contraception, the fibroids can distort the uterine cavity and the theoretical concern is it may be less effective for contraception. But for bleeding, if the IUD fits, then it is totally acceptable to use.
Thank you for writing about this. I have a question about continuing to take progesterone after a lapascopic hysterectomy aged 49 (post menopause). Outside of the known increased risk of breast cancer, is there any reason why I could not continue with oestrogen and progesterone post hysterectomy? My sleep is rubbish without progesterone. I wake up frequently in the night. Also, there is a sliver of uterus remaining that is supplied with blood by an artery from the type of surgery. Is this reason to advocate for progesterone? Is there risk of cancer of the uterus still? I was considered at risk of a sarcoma for the hysterectomy and had previously had a large myome removed at age 34 before having children. My gyn hates HRT and wants me to stop but that is a no from me.
I am not sure what you mean by a sliver of uterus. If any of the uterus is left behind, the recommendation is to give progesterone/progestin if we are giving estrogen, as there is a risk that cancer can develop in the part left behind. The situation where some of the uterus can be left behind is a supracervical hysterectomy. The reason to take hormones is either treatment or symptoms of prevention of osteoporosis for those at high risk. The risk with the progesterone/progestin is breast cancer, so people need to balance that small but real risk against the benefits.
I find it so odd that each menopause expert who is a published author or on a social platform has a different perspective. Reading the newest research material (and not all has been brought forward by several menopause societies) debunks so much of the information that women are being provided. I guess that is why everyone of us chooses a person after reading a book, going to a specific practitioner , or following the newest social media post guides us to selecting a method of dealing with menopause issues which we have for life. Ageism should never be acceptable and when health care people go back to the WHI (when oral estrogens were used) and what the menopause societies use as the "bible" for care women suffer and go from one doctor to another for every issue that the lack of estrogen can do. My soap box sorry I am not only discouraged, but also astounded that women have not all put their heads out a window like Network) and yelled I will not take this anymore!!!
I follow the science and The Menopause Society. Some choose not to do that, and I guess the controversy and also telling women that estrogen solves every issue appears to help them sell supplements, weighted vests, and charge between $1500-$35000 for a new appointment.
In this province once a woman is over 70 (and we can get away with 71 or 72) no more mammograms, paps and colon cancer checks including FIT tests. OHIP will not pay for the tests. Yes we can get an ultrasound, MRI or CT scan but only if a GP thinks it is required. We are allowed 15 minute appointments here. GP's no longer to pelvic exams (at least the few I have polled as well as the one I go to), we wait for months to see a specialist. The only menopause clinics that are funded by OHIP at one major city have extremely long wait times up to 2 years. By that time the words "too old to help" ring true! Naturopaths and functional or integrative medical people are not covered by our province health care and what they prescribed is not either. Once a woman is over 65 the government decides what medications women can have prescribed and if denied no insurance company will fund some of the cost (includes patches, gels, sprays and in some cases vaginal estrogen). We can be treated for thyroid hormone issues but not female hormones (even under 65 not covered by insurance). Men can have a prostate exam and treatment at any time of their lives. Ageism and misogyny in medicine happens daily.
Would you consider writing about post-menopausal bleeding for women on HRT, and whether there are any solutions beyond raising progesterone and/or lowering estrogen?
I remember reading that removal of ovaries (unless medically indicated) prior to age 65 raised the risk for heart disease. Thus, I am surprised to read the opposite here.
Great explanation of fibroids. I'm planning on making a patient info sheet out of some of the information you have here. Is that okay? Also, how do they come up with a cost of 6 - 34 billion dollars? What does that statement mean exactly?
Love all the emails I get from you. They are super helpful.
Thank you for this thorough and informative article!
I’m so pleased others have access to this info now! I had a hysterectomy (ovaries not removed) 7 years ago after maybe 5 years of ridiculously heavy bleeding. Dr at the time chalked it up to perimenopause until the bleeding got so obstructive to my life that i got an ultrasound and he found a softball sized fibroid. By the morning of my surgery, my hemoglobin was 6, which explained my obsessive (and shameful to me) ice chewing. I wish I’d advocated for myself better all those years by presenting more clear and accurate descriptions of my issue, because just saying “heavy bleeding” to my Dr likely trivialized the epic bleeding I was enduring. Anyway, glad you’re on this earth!
Thank you for this deep dive, Dr. Gunter. Incredibly timely. I’m 52, post menopausal with 2 new fibroids since I started MHT at age 50. Your article will help me make informed choices moving forward.
Interesting. I was never informed that after my hysterectomy (ovaries not removed) that I was at an increased risk of heart disease.
Also - I wonder if at some point it’s in you wheelhouse to discuss vaginal atrophy, UTIs linked to that condition, and dryness in menopause. Thank you.
If you go to The Hormone Therapy Guide under section 4 I have six posts about all the different therapies for genitourinary syndrome of menopause and all the treatment options and how to troubleshoot when they are not helping https://vajenda.substack.com/p/gunters-guide-to-the-hormone-menoverse
Dr. Kelly Casperson has some great videos on this.
“Removal of the fibroid, with either a myomectomy or hysterectomy., is also recommended whenever there is a concern about cancer.”
How does a woman know if there is concern about cancer when being diagnosed with fibroids? I’ve seen three different gynecologists in the past year and a half, and I have zero faith that they care if I have cancer or not.
Concerning signs are rapid growth at any age, or for anyone in menopause fibroids that are growing or are causing pai.
"or for anyone in menopause fibroids that are growing or are causing pai. " That was me for years. They just kept growing and growing despite assurances from my doctor that they would shrink because I had gone through menopause. No one ever mentioned the possibility of cancer. I had no idea that could be a problem.
Thank you for the article. I couldn't comment on it before, because it sent me to a dark place. I had fibroids, for years. Lots of debilitating pain. My doctors kept telling me that they would shrink when I went through menopause, so nothing needed to be done. This went on for years as the fibroids continued to grow and the pain got worse and worse. In 2019 (years after I had supposedly gone through menopause), the doctors finally decided that something needed to be done. I was in so much pain I was now missing work frequently and had difficulty driving. Their decision was that I needed a hysterectomy. Mine was the last elective surgery done right before the pandemic in March 2020. They sent me home the day of the surgery with a catheter in place that I would later have to remove myself. I went from sick leave to working from home. All I got after the surgery was three phone calls - two checking in on me, and one chewing me out for not answering the phone for the second call. (I did and spoke to a someone helping out (trainee? intern? I can't remember) and her report never made it into my record. I mostly feel better, although the surgery caused some additional issues I am trying to get my doctors to take seriously.
Thank you for this brilliant and thorough piece. I had extensive fibroids that resulted in extremely heavy, unpredictable bleeding about six years ago, and ultimately underwent a total hysterectomy as the tissue of my uterus was completely “seeded”/compromised. I was misdiagnosed with perimenopausal bleeding (when I soaked the mattress one night I had a feeling that it was more) and it took months and the right gyn to figure things out! As usual, women need more information and awareness - so thank you so much, you are a blessing to us all!!! ❤️
Great information. Thank you! Can you address whether there is any evidence that women can make lifestyle changes, eg. in their eating/diet that can shrink fibroids? There is anecdotal talk of nutrition and herbal/supplement regimen helping to shrink fibroids but I haven’t been able to find any evidence based concrete information.
Thank you so much for sharing your knowledge, research, takes and information with us, greatly appreciated!
I just turned 50, and I’m experiencing minor symptoms, one is heavy bleedings during still quite regular periods (probable cause for persistent low ferritin levels, effecting iron levels) and the other might be the intensification of existing depression. My question is therefor manyfold and concerns the effect on fibroids (and possibly depression) by treating this bleeding with local hormonal treatment with the Mirena. Prior to placing it my state of depression was elaborately discussed (irt effect of hormones) and an ultrasound was done to explain possible other (than hormonal) causes for abnormal bleedings 3 (relatively small) fibroids were found. My ObGyn placed the Mirena nonetheless, after comforting my immediately expressed concerns. After, I read in the manual the Mirena should not be placed in the presences of fibroids, which I see confirmed in this article, saying that hormones can cause growth of fibroids. Besides the manual states depression as a top side-effect. When consulting my GP for a second opinion —either from my GP or another ObGyn— my concerns were again dismissed, as was my urge to remove the Mirena immediately. “the pros should outweigh the cons”. I am worried for the opposite. I am also confused, as the ObGyn says it might reduce the fibroids. Could you shine your light on the validity of my concerns? And how to read this contradictory information?Depression effect might be a difficult one, as the Mirena hormones act mainly local, but anything about the effect on the fibroids would be very helpful in my journey to advocate for the best care. Thank you so much!! HNY, from the Netherlands.
We place Mirena IUDs with fibroids for the treatment of heavy bleeding, especially in the presence of smaller fibroids. The issue is for contraception, the fibroids can distort the uterine cavity and the theoretical concern is it may be less effective for contraception. But for bleeding, if the IUD fits, then it is totally acceptable to use.
Thank you for writing about this. I have a question about continuing to take progesterone after a lapascopic hysterectomy aged 49 (post menopause). Outside of the known increased risk of breast cancer, is there any reason why I could not continue with oestrogen and progesterone post hysterectomy? My sleep is rubbish without progesterone. I wake up frequently in the night. Also, there is a sliver of uterus remaining that is supplied with blood by an artery from the type of surgery. Is this reason to advocate for progesterone? Is there risk of cancer of the uterus still? I was considered at risk of a sarcoma for the hysterectomy and had previously had a large myome removed at age 34 before having children. My gyn hates HRT and wants me to stop but that is a no from me.
I am not sure what you mean by a sliver of uterus. If any of the uterus is left behind, the recommendation is to give progesterone/progestin if we are giving estrogen, as there is a risk that cancer can develop in the part left behind. The situation where some of the uterus can be left behind is a supracervical hysterectomy. The reason to take hormones is either treatment or symptoms of prevention of osteoporosis for those at high risk. The risk with the progesterone/progestin is breast cancer, so people need to balance that small but real risk against the benefits.
I find it so odd that each menopause expert who is a published author or on a social platform has a different perspective. Reading the newest research material (and not all has been brought forward by several menopause societies) debunks so much of the information that women are being provided. I guess that is why everyone of us chooses a person after reading a book, going to a specific practitioner , or following the newest social media post guides us to selecting a method of dealing with menopause issues which we have for life. Ageism should never be acceptable and when health care people go back to the WHI (when oral estrogens were used) and what the menopause societies use as the "bible" for care women suffer and go from one doctor to another for every issue that the lack of estrogen can do. My soap box sorry I am not only discouraged, but also astounded that women have not all put their heads out a window like Network) and yelled I will not take this anymore!!!
I follow the science and The Menopause Society. Some choose not to do that, and I guess the controversy and also telling women that estrogen solves every issue appears to help them sell supplements, weighted vests, and charge between $1500-$35000 for a new appointment.
In this province once a woman is over 70 (and we can get away with 71 or 72) no more mammograms, paps and colon cancer checks including FIT tests. OHIP will not pay for the tests. Yes we can get an ultrasound, MRI or CT scan but only if a GP thinks it is required. We are allowed 15 minute appointments here. GP's no longer to pelvic exams (at least the few I have polled as well as the one I go to), we wait for months to see a specialist. The only menopause clinics that are funded by OHIP at one major city have extremely long wait times up to 2 years. By that time the words "too old to help" ring true! Naturopaths and functional or integrative medical people are not covered by our province health care and what they prescribed is not either. Once a woman is over 65 the government decides what medications women can have prescribed and if denied no insurance company will fund some of the cost (includes patches, gels, sprays and in some cases vaginal estrogen). We can be treated for thyroid hormone issues but not female hormones (even under 65 not covered by insurance). Men can have a prostate exam and treatment at any time of their lives. Ageism and misogyny in medicine happens daily.
Would you consider writing about post-menopausal bleeding for women on HRT, and whether there are any solutions beyond raising progesterone and/or lowering estrogen?
I remember reading that removal of ovaries (unless medically indicated) prior to age 65 raised the risk for heart disease. Thus, I am surprised to read the opposite here.
Great explanation of fibroids. I'm planning on making a patient info sheet out of some of the information you have here. Is that okay? Also, how do they come up with a cost of 6 - 34 billion dollars? What does that statement mean exactly?
Love all the emails I get from you. They are super helpful.
Very Interesting. Does the same hold true for ovarian cysts?