<div>Natural history of uterine fibroids during perimenopause and menopause</div><div>Michelle Louie, MD MSCR<sup>1</sup>; Heidi E. Kosiorek,
MS<sup>1</sup>, MS; Reem A. Alsibai<sup>2</sup>;
Cherie-Akilah Browne<sup>2</sup>; Sarah Rassier MD,
MPH<sup>2</sup>; Shannon K. Laughlin-Tommaso,
MD<sup>2</sup></div><div>1 Mayo Clinic</div><div>Department of Medical and Surgical Gynecology</div><div>5777 E. Mayo Blvd, Phoenix, AZ 85054</div><div>2 Mayo Clinic</div><div>Department of Obstetrics and Gynecology</div><div>200 First Street SW, Rochester, MN 55905</div><div>Disclosure statement: Michelle Louie is a consultant for Hologic Inc.
and Applied Medical. None of the other authors have any conflicts of
interest to report.</div><div>Source(s) of financial support: None</div><div>Corresponding Author:</div><div>Michelle Louie, MD MSCR</div><div>Mayo Clinic</div><div>Department of Medical and Surgical Gynecology</div><div>5777 E. Mayo Blvd, Phoenix, AZ 85054</div><div>(p) 480-342-0612</div><div>(f) 480-342-2944</div><div>Louie.Michelle@mayo.edu</div><div>Since fibroids are known to be hormonally receptive tumors, it is
biologically plausible that fibroids decrease in size after menopause.
Patients may opt for more conservative therapy or expectant management
if fibroid growth could be
predicted<sup>1</sup>. Studies
assessing fibroid growth in premenopausal patients have shown that
individual tumors in a single uterus grow at different rates and can
grow consistently or in short bursts<sup>2</sup>. These
variations and the unknown effect of natural menopause make patient
counseling difficult. Studies that include only symptomatic menopausal
patients or those undergoing treatment can result in selection bias
towards fibroids that are increasing in size<sup>3,4</sup>. The
objective of our study was to estimate fibroid growth course before and
after menopause among women not specifically seeking fibroid treatment.
Our hypothesis was that fibroid growth would decline after menopause.</div><div>Patients seeking care at the Mayo Clinic Women’s Health Clinic were
included in the Data Registry on Experiences of Aging, Menopause, and
Sexuality (DREAMS) study<sup>5</sup> in 2017 and gave consent for
use of medical records in research (IRB #11-004280). Primary
indications for consultation included hormonal and non-hormonal
management of menopausal symptoms and concerns about sexual health
including desire and arousal. We performed a retrospective cohort study
of participants from the DREAMS study with an intact uterus and ≥2
pelvic ultrasounds with fibroid size measurements. Ultrasounds
&lt;3 months apart were excluded. Menopausal status, hormone use,
and demographic information were ascertained via chart review. Patients
were categorized by menopausal status at their initial ultrasound.
Growth rate (%) over 12 months was calculated and we defined a
clinically significant change in growth rate as &gt;50%
increase or decrease. Patient characteristics and growth rate (%, 12
months) were compared between groups using chi-square test for frequency
data and Kruskal-Wallis rank sum test for continuous measures. P values
&lt;0.05 were considered statistically significant. R version
4.1.2 was used for statistical analysis.</div><div>73 patients met inclusion criteria: 38 premenopausal (median age 43.5,
range 24-53), 13 perimenopausal (median age 51, range 44-56), and 22
postmenopausal (median age 56, range 50-74. Three premenopausal and one
perimenopausal patient were using hormone medications during the study
period. There were no significant differences between groups with
respect to race (92% White, p=0.34), ultrasound indication (p=0.12),
and interval between scans (median 2 years, p=0.65). Median diameter of
the largest fibroid on second scan decreased with menopausal transition,
from 2.5 cm in premenopausal patients to 2.3 cm in perimenopausal
patients to 1.7 cm in postmenopausal patients (p=0.04). 12-month fibroid
growth rate was stable (median 0%), and not different between groups
(p=0.84) [Figure 1]. 35 (92.1%) of premenopausal, 12 (92%) of
perimenopausal, and 21 (95.4%) of postmenopausal participants had a
decrease or no clinically meaningful change in 12-month growth rate. 3
(8%) of premenopausal, 1 (8%) of perimenopausal, and 1 (5%) of
postmenopausal participants had a greater than 50% increase in growth
rate.</div><div>In our cohort of patients presenting for menopausal or sexual health
concerns, we did not observe clinically significant fibroid growth
during perimenopause or menopause. 12-month fibroid growth rate appears
to stabilize with menopausal status, with less variability for
menopausal patients compared to peri- or pre-menopausal patients. Due to
the very low proportion of patients using hormone therapy, no further
analysis of the effect of hormone therapy was completed. Our cohort was
chosen to attempt to capture the natural history of fibroids through the
menopausal transition and aid in counseling the asymptomatic patient.
Future studies of larger and more diverse groups would help to determine
the natural history of large fibroids and the effect of hormone therapy
and patient characteristics such as race, ethnicity, weight, and medical
comorbidities.</div><div>References</div><div>1 Borah, B. J., Nicholson, W. K., Bradley, L. &amp; Stewart, E. A. The
impact of uterine leiomyomas: a national survey of affected women.<i>Am J Obstet Gynecol</i> 209, 319 e311-319 e320,
doi:10.1016/j.ajog.2013.07.017 (2013).</div><div>2 Peddada, S. D. <i>et al.</i> Growth
of uterine leiomyomata among premenopausal black and white women.<i>Proc Natl Acad Sci U S A</i> 105, 19887-19892 (2008).</div><div>3 Shen, Minghong MD1,2; Duan, Hua MD, PhD1; Chang, Yanan MD1; Wang, Sha
MD1. Growth of surgically confirmed leiomyomas in postmenopausal women:
analysis of the influencing factors. Menopause 28(11):p 1209-1213,
November 2021. | DOI: 10.1097/GME.0000000000001846</div><div>4 Cohen Rassier, Sarah L. MD, MPH; Louie, Michelle Y. MD; Hopkins,
Matthew R. MD; Stewart, Elizabeth A. MD; Laughlin-Tommaso, Shannon K.
MD. Letter to the Editor re Shen et al. Menopause 29(8):p 999, August
2022. | DOI: 10.1097/GME.0000000000002043</div><div>5 Faubion SS, Kapoor E, Kling JM, Kuhle CL, Sood R, Rullo JE, Thielen
JM, Shuster LT, Rocca WA, Hilsaca KSF, Mara KC, Schroeder DR, Miller VM.
Data Registry on Experiences of Aging, Menopause, and Sexuality
(DREAMS): A cohort profile. Maturitas. 2018 Jan;107:44-49. doi:
10.1016/j.maturitas.2017.09.013. Epub 2017 Oct 5. PMID: 29169579.</div><div>Figure Legend:</div><div>Figure 1: Distribution of the 12-month growth rate by initial menopause
status. Displayed is a boxplot; horizontal line is the median, top and
bottom of the box are the 25th and 75th percentiles. Outliers are shown
as points outside the box and whiskers.</div>