Fibroids & Hormones: What every woman deserves to know
Introduction
Fibroids are a reality for the vast majority of women—by age 50, up to 80% will have at least one. Yet, myths, anxiety, and confusion persist. In a candid conversation on “Hormones & Hope,” Dr. Chhaya Makhija interviews Dr. Cheruba Prabhakar, renowned gynecologist, menopause specialist, and minimally invasive surgeon known as “The Fibroid Doc.” Together, they break down the science, symptoms, and solutions every woman should know.
Fibroids 101—What Are They, and Who Gets Them?
Fibroids are benign (non-cancerous) tumors made of smooth muscle that grow in the uterus. They can appear:
Inside the uterine cavity (submucosal)
Within the uterine wall (intramural)
On the outer surface of the uterus (subserosal)
“80% of women will be diagnosed with a fibroid by the time they're 50. For women of color, it's actually even higher—90%.”
Why do fibroids form?
The exact cause is unknown, but risk factors include:
Genetics (family history)
Race (higher risk for Black and South Asian women)
Diet (red meat, chemical hair straighteners)
Possible links to endocrine disruptors (plastics, chemicals)
Symptoms—The Silent and the Obvious
Fibroids are notorious for being sneaky. Many women have no symptoms—sometimes even with fibroids as large as a grapefruit!
Common symptoms:
Heavy or prolonged periods
Pelvic pain or pressure
Frequent urination
Pain during sex
Infertility
“Patients often don't know because it's slowly been growing over many years. You think you’ve put on some weight or are just bloated, but it takes a good exam to figure out something’s not right,” Dr. Prabakar says.
Not all fibroids cause heavy bleeding; it depends on their location, with submucosal fibroids being most likely to cause it.
Diagnosis. How Are Fibroids Found?
There is no universal screening test for fibroids. The best approach is:
Annual pelvic exam by a gynecologist
Ultrasound (preferably transvaginal) for accurate imaging
MRI for complex or suspicious cases
Dr. Prabakar points out that “a good pelvic exam is the best screening test. If something feels off, an ultrasound—preferably transvaginal—is the next step. MRI is the gold standard for complex cases.”
Skipping annual exams is a common reason fibroids are missed.
Fibroids and Fertility. What’s the Real Impact?
Fibroids can interfere with fertility, but not all require treatment.
Submucosal fibroids (inside the cavity): Even small ones can block implantation and increase miscarriage risk. Removal is usually recommended for those trying to conceive.
Intramural or subserosal fibroids: Only removed if large (4-5 cm or more) or causing symptoms.
Multiple small fibroids: Can create an unfavorable environment for pregnancy.
According to Dr. Prabakar, “Even if it’s just one centimeter but inside the cavity, I recommend removal for women trying to get pregnant. Multiple small fibroids can also make pregnancy difficult.”
Surgery is often helpful for fibroids inside the uterine cavity.
Fibroids Across the Life Span Perimenopause and Menopause
Perimenopause (around age 40-45): Fibroids rarely grow, but hormonal imbalances can occasionally cause growth.
Menopause (average age 49-50): Fibroids usually shrink due to lower estrogen.
Red flag: Rapid growth after age 50 warrants evaluation for cancer.
In Dr. Prabakar’s words, “once you reach 49, 50, which is the average age of menopause, the lack of estrogen actually makes them shrink a little bit.”
Are Fibroids Cancerous?
Most fibroids are benign.
Dr. Prabakar highlights this point: “Most fibroids are benign. I have seen some malignant ones—maybe three in my entire career and I’ve seen hundreds and hundreds of patients with fibroids.”
How do doctors check for cancer?
Imaging: Benign fibroids have a smooth, well-defined capsule. Irregular shape, invasion into the uterine wall, or disorganized blood vessels may raise suspicion.
MRI: The best imaging tool for distinguishing benign from suspicious fibroids.
Biopsy: Not possible without surgery; cancer is usually diagnosed after removal.
Myths, Diet, and Natural Remedies
Common Myths
Do birth control pills make fibroids grow? Not always.
Will fibroids shrink after menopause? Usually, yes.
Can you prevent fibroids with diet alone? Maybe, but evidence is limited.
Diet and Lifestyle
Cruciferous vegetables (cauliflower, broccoli) may help decrease fibroid size.
Vitamin D supplementation is linked to reduced fibroid growth.
Red meat and chemical hair straighteners may increase risk.
Castor oil packs, herbal supplements, and TikTok “hacks” have no proven effect.
As Dr. Prabakar puts it, “If rubbing castor oil on your abdomen or taking some pill or some herb took away our fibroids, well, we wouldn’t have a fibroid pandemic.”
Lifestyle Tips
Eat a balanced, anti-inflammatory diet
Get enough sleep
Stay active
Maintain annual gynecologic care
What Should You Do If You Have Fibroids?
Don’t panic: Most fibroids are benign.
See a board-certified gynecologist: Annual exams are key.
Get the right imaging: Transvaginal ultrasound or MRI if needed.
Discuss options: Treatment depends on symptoms, size, location, and fertility goals.
Build a care team: Especially if you may want children in the future or if you have symptoms.
According to Dr. Prabakar, “Having a well-rounded team is very helpful because maybe you won’t do something about it this year, but in five years you may want to get pregnant, or in ten years they may cause symptoms.”
Hormone Therapy and Fibroids—Clearing Up the Confusion
Is hormone therapy safe if you have fibroids?
Yes, for most women with small, benign-appearing fibroids.
“Menopause hormone therapy has such small doses of estrogen that this is not going to set off your fibroid growth, especially among perimenopause.” Dr. Prabakar clarifies.
The estrogen dose in HRT is much lower than in birth control pills.
Annual monitoring with ultrasound is recommended.
Key Takeaways:
Fibroids are extremely common and usually benign.
Annual gynecological exams and the right imaging are critical.
Most symptoms can be managed with medical or minimally invasive surgical options.
Don’t fall for internet myths—seek expert advice and evidence-based care.
Conclusion
Fibroids don’t have to be a source of fear or confusion. With expert guidance, up-to-date information, and a supportive care team, you can take control of your health and make the best decisions for your body and your future.
As Dr. Prabakar eloquently states, “Education and knowledge are powerful tools. The right expertise can alleviate so much anxiety and help you take control of your health journey.”
If you have questions or concerns about fibroids, don’t hesitate to reach out to a board-certified specialist and make use of trusted resources. Your health—and your peace of mind—are worth it.
Ready to learn more?
Watch “Hormones & Hope” with Dr. Chhaya Makhija on YouTube, Spotify, and Apple Podcasts for more expert conversations and empowering health insights.