HRT and fibroids

Key takeaways

• Fibroids are not a contraindication to HRT. Most women with fibroids can take HRT safely, but specialist assessment and ongoing monitoring are important.
• HRT may stimulate some fibroid growth, particularly in the first two years of use. The effect varies depending on the type and formulation of HRT, which is why formulation choice should be discussed with a specialist.
• Unexplained heavy bleeding while on HRT requires prompt medical assessment. It is not something to attribute to HRT and wait out.

If you have fibroids and have been told, or have assumed, that HRT is off the table for you, you are not alone. It is one of the most common reasons women with menopause symptoms do not pursue treatment. And in many cases, it is based on a misunderstanding of the evidence.

Fibroids are not a contraindication to HRT. That is the clinical consensus, set out in NICE guideline NG23 and supported by a growing body of peer-reviewed evidence. What the evidence also shows is that the picture is nuanced: the type of HRT matters, monitoring is important, and there are specific symptoms that do warrant prompt attention.

This article sets out what fibroids are, how menopause affects them, what the research says about HRT and fibroid growth, and what to do if you have fibroids and want to discuss HRT properly.

What are fibroids?

Fibroids (also called uterine fibroids or leiomyomas) are growths that develop in or around the uterus. They are made of muscle and fibrous tissue, are almost always non-cancerous, and vary widely in size. Some are small enough to go unnoticed; others cause symptoms significant enough to affect daily life.

Common symptoms include heavy or prolonged periods, pelvic pain or pressure, frequent urination, and lower back discomfort. Many women with fibroids have no symptoms at all and are unaware they have them. Fibroids are diagnosed through ultrasound, and sometimes through more detailed imaging or assessment depending on the size and location involved.

How common are fibroids, and who is most affected?

More common than most people realise. A systematic review published in BJOG (Stewart et al., 2017) found that fibroids occur in approximately 70% of women by age 50. In the UK specifically, a study drawing on primary care data published in BMC Women's Health (Brinicombe et al., 2016) found an incidence of 5.8 per 1,000 woman-years, with a significant proportion of cases identified only through procedures for heavy bleeding, suggesting that many fibroids in UK primary care go unrecorded.

Among women aged 40 to 49, research published in BMC Women's Health (Zimmermann et al., 2012) found a self-reported prevalence of 9.4% in the UK, with over half of women with diagnosed fibroids reporting that their symptoms negatively affected their quality of life.

One finding from the Stewart et al. systematic review is worth naming clearly: Black ethnicity is the single strongest risk factor identified for fibroids, with Black women significantly more likely to develop them and to experience more severe symptoms. This is not a reason for any group to approach this topic differently, but it is important context.

Women from all backgrounds deserve to understand their risk and feel confident seeking care.

What happens to fibroids during perimenopause and menopause?

Fibroids are oestrogen-sensitive. As oestrogen levels fall during and after menopause, fibroids tend to shrink naturally over time. For many women, symptoms that were significant during the reproductive years improve after menopause without any intervention.

This is why perimenopause is sometimes a complicated period for women with fibroids: as oestrogen fluctuates before it falls, fibroid behaviour can be unpredictable. Some women experience a worsening of symptoms in perimenopause before things settle post-menopause.

A systematic review published in Medicina (Moro et al., 2019), which examined 17 studies involving 1,122 participants, provides the most comprehensive available evidence on the HRT and fibroid interaction. Its key finding: available data suggest that HRT regimen choice is crucial, and that fibroid response to HRT varies significantly by formulation.

Can you take HRT if you have fibroids?

Yes, in most cases. Having fibroids is not a contraindication to HRT.

NICE guideline NG23 recommends an individual benefit and risk discussion tailored to the woman's age, circumstances, and risk factors. Fibroids are part of that picture, but they do not automatically rule out treatment.

What this means in practice: a woman with fibroids who is experiencing significant menopause symptoms should not assume HRT is unavailable to her. What she should do is have that conversation with a specialist who has the time and clinical knowledge to weigh her individual situation, assess her fibroid history, and discuss the most appropriate formulation and monitoring plan.

“The benefits of HRT, including relief from vasomotor symptoms, improved sleep and mood, long-term bone health, and cardiovascular protection, do not disappear because someone has fibroids. For many women, those benefits are significant enough that avoiding HRT entirely, without exploring the evidence, is not in their best interest.”

Katy Jackson, Clinical Director - Women's Health

Can HRT make fibroids worse?

It can, in some women, and this is important to understand rather than dismiss.

A prospective study published in Maturitas (Yang et al., 2002) found that HRT does statistically increase fibroid volume, but that the effect is concentrated in the first two years of use. By year three, fibroid volume begins to stabilise or decline in both HRT users and non-users. This study used oral conjugated equine oestrogen, an older formulation, so the findings may not fully reflect how modern transdermal HRT performs. They are worth noting as supporting evidence rather than a definitive finding.

What the overall body of evidence, including the Moro et al. systematic review, supports is this: HRT does not cause new fibroids to develop. It may stimulate growth in existing fibroids, but the degree of that effect depends significantly on the type and formulation of HRT used. This is why formulation choice is not a minor consideration for women with fibroids.

Does the type of HRT matter if you have fibroids?

Yes, and this is the question none of the commonly found articles on this topic answer. It is also one of the most clinically relevant.

A study published in Fertility and Sterility (Sener et al., 1996) comparing oral and transdermal HRT found that transdermal delivery was associated with a significant increase in fibroid size at one year, while oral HRT showed no significant change in that study. The sample size was small and the formulations are older, so this should be treated as directional evidence rather than a definitive guide.

What this means practically: no single HRT formulation can be said to be categorically the right choice for all women with fibroids. What matters is that the choice is made deliberately, with knowledge of your fibroid history, in discussion with a specialist who understands the evidence and can monitor the outcome.

This is exactly the kind of conversation that requires more than a standard appointment.

What symptoms should you monitor on HRT if you have fibroids?

Monitoring matters. Women with fibroids who start HRT may choose to have a plan for how fibroid size and behaviour will be tracked over time, typically through periodic ultrasound. Beyond scheduled monitoring, there are specific symptoms that require prompt medical assessment and should not be attributed to HRT without investigation.

Unexplained heavy uterine bleeding while on HRT needs clinical assessment. This is not a side effect to manage at home or wait out. Heavy bleeding can indicate fibroid growth, endometrial changes, polyps, or other conditions that require investigation. If you experience unexpected or significantly increased bleeding while on HRT, contact your GP or specialist promptly. This is a clinical flag, not a passing mention.

Other symptoms worth reporting to your specialist include new or worsening pelvic pain or pressure, a feeling of abdominal fullness or bloating that is new, or any change in urinary frequency that cannot be explained otherwise.

A 45-minute consultation with a BMS-trained menopause specialist provides the time to establish what your monitoring plan should look like before you start treatment, and to review it if anything changes.

What are the benefits of HRT that make it worth considering despite fibroids?

This is the question that often gets lost in conversations about HRT risks and fibroids, and it matters.

HRT relieves vasomotor symptoms (hot flushes and night sweats), improves sleep, supports mood and cognitive function, protects bone density, and is associated with reduced cardiovascular risk in women who start it at the right time. For women who are significantly symptomatic during perimenopause or menopause, the impact of not treating those symptoms is also a clinical consideration.

NICE NG23 frames HRT decision-making as a benefit and risk discussion, not a risk-only calculation. Fibroids are part of that picture, but so are the benefits of treatment. A woman with well-managed, monitored fibroids should not be in a worse position than any other woman when it comes to accessing that conversation.

Voy outcome data, presented at The Menopause Society 2025 (forthcoming in Climacteric), found that 88% of members felt more hormonally balanced at three months, compared to 62% of women receiving standard care. In the same dataset, 93% reported an improvement in overall quality of life. The difference between those two figures and the standard care benchmark reflects what specialist-led, monitored menopause care produces when there is time and expertise to get treatment right.

Getting specialist support: what to do next

If you have fibroids and have been putting off exploring HRT because you assumed it was not an option for you, the most useful next step is a proper specialist assessment, not another Google search.

A 45-minute consultation with a BMS-trained menopause specialist gives you the time to discuss your fibroid history, understand your individual benefit and risk profile, talk through which HRT formulation would be most appropriate, and establish a monitoring plan. That is a fundamentally different conversation from a standard GP appointment.

For women who remain anxious about systemic HRT, vaginal oestrogen is worth discussing as an option. It acts locally, has very low systemic absorption, and can address some menopause symptoms without the same level of systemic oestrogen exposure as other HRT types. A specialist can advise whether it is appropriate for your situation.

Voy's menopause consultations are rated 4.7 out of 5 on Trustpilot across 7,000 or more reviews. The team includes BMS-trained specialists who have the clinical knowledge to work through complex situations, including women with fibroids, and build a treatment plan that reflects the full picture.