Fibroids and Perimenopause: What's the Connection?

If you're a Black woman, there's a significant chance you already know what fibroids are — possibly from personal experience. Uterine fibroids affect up to 80% of Black women by age 50, compared to about 70% of white women. But beyond the higher prevalence, Black women tend to develop fibroids earlier, have more of them, and experience more severe symptoms.

So what happens when fibroids meet perimenopause?

The Complicated Relationship

Fibroids are estrogen-dependent growths. During perimenopause, your estrogen levels fluctuate wildly — sometimes surging higher than they've ever been before dropping. This hormonal roller coaster can:

• Make existing fibroids grow during estrogen surges
• Cause heavier bleeding than you've ever experienced
• Create new fibroids even if you've never had them before
• Mask perimenopause symptoms — when your periods have always been heavy and painful, it's hard to know what's "normal heavy" vs. "perimenopause heavy"

Symptoms to Watch For

During perimenopause with fibroids, pay attention to:

• Periods that are significantly heavier than your baseline
• Bleeding that lasts longer than 7 days
• Passing large clots (bigger than a quarter)
• Needing to change your pad or tampon every hour
• Pelvic pressure or pain that's increasing
• Anemia symptoms: fatigue, dizziness, shortness of breath

Treatment Options During Perimenopause

Watchful waiting. If your fibroids are small and symptoms are manageable, your doctor may recommend monitoring them. Many fibroids shrink after menopause when estrogen levels drop.

Medical management. Hormonal IUDs, tranexamic acid for heavy bleeding, or short-term hormonal treatments can help manage symptoms.

Minimally invasive procedures. Uterine fibroid embolization (UFE), myomectomy, or focused ultrasound can treat fibroids while preserving your uterus.

Hysterectomy. This remains the only definitive treatment, but it should never be the first option presented — and you always have the right to explore alternatives.

Advocating for Yourself

Black women undergo hysterectomy at higher rates than women of other races, and there's evidence that less invasive options are offered less frequently. Know your options. Ask questions. Get a second opinion if something doesn't feel right.

Track your bleeding patterns, pain levels, and symptoms in Ohemaa so you can walk into every appointment with data your doctor can't dismiss.