Highlights
Uterine leiomyomas remain common through midlife and do not predictably disappear after menopause. Longitudinal data suggest heterogeneous behavior: some fibroids shrink, some remain stable, and a subset continue to enlarge.
In perimenopausal and postmenopausal patients, abnormal uterine bleeding and pelvic pain should not be attributed to fibroids by default. Endometrial pathology and other gynecologic or nongynecologic causes require systematic exclusion.