Hormone replacement therapy does not cause problems with fibroids in most cases, but occasionally it results in heavy withdrawal bleeding. This calls for an investigation, to check where the fibroids are and what they are doing. If they are bulging into the cavity of the uterus, consideration may be given to removal of the endometrium by the technique described in chapter 7 (endometrial ablation). Fibroids generally shrink rapidly after menopause due to the reduction in overall oestrogen levels, or they may remain the same size. However, if you are on HRT your fibroids may shrink less quickly. High-dose oestrogen, especially in the form of implants, may produce significant growth in uterine fibroids, so you should avoid this way of taking it in.
Lorraine’s experience of postmenopausal HRT included prolonged and heavy bleeding each month. Unusually, this persisted even after endometrial ablation. Her gynaecologist made a full assessment and gave Lorraine the option of stopping the HRT or, if she wanted to continue with it, to have a hysterectomy or a repeat ablation. She decided to withdraw from HRT and found her other major menopausal symptoms— flushes, vaginal dryness, insomnia and mood swings — were becoming less distressing.