Endometriosis After Menopause – What To Expect

Endometriosis is one of the most common reproductive health disorders for female-bodied people. According to the World Health Organization (WHO), about 10% of women and girls across the globe are impacted by endometriosis. Unfortunately, they do not have a gender-inclusive statistic, but this number most likely reflects other people who were assigned female at birth (AFAB).

Symptoms of endometriosis are typically the worst before and during menstruation. Because of this, it would make sense that someone with the disorder would find relief when they reach menopause and are no longer menstruating. 

That’s not the case for everyone. Can you still experience symptoms of endometriosis after menopause? It’s time to find out!

What Is Endometriosis?

If you have endometriosis, then you know just how much pain and discomfort it can cause. But what exactly is this disorder? 

Endometriosis occurs when tissue similar to endometrium (the lining of the uterus) grows in other places in the abdominal and pelvic cavity. The disease can cause growths in the lining of the pelvis, the fallopian tubes, ovaries, and other areas.

These growths lead to chronic inflammation, causing some people to develop scar tissue in affected areas. People with endometriosis may experience symptoms that interfere with their daily lives, especially during their period.

Symptoms of endometriosis:

• Heavy periods, may also experience heavy bleeding between periods
• Abdominal or lower back pain during period
• Pain during penetration
• Pain while using the bathroom
• Fatigue
• Bloating
• Nausea and vomiting
• Mental health symptoms like depression and anxiety
• Infertility

The cause of endometriosis is unknown, and while there is no cure, symptoms can somewhat be managed depending on the individual. Symptoms typically subside after menopause, but not always. 

Menopause Refresher

Someone is considered to have reached menopause when they go 12 consecutive months without a period. The average age of menopause is 51, but people go through perimenopause for an average of four to eight years before fully reaching menopause.

During perimenopause, people may experience symptoms like hot flashes, difficulty sleeping, vaginal dryness, and emotional changes. These symptoms can often be managed with hormone replacement therapy or natural methods like acupuncture and dietary changes.

People who have very difficult menstrual cycles are often relieved once menopause rolls around, as it means the end of uncomfortable symptoms. This is true for many people with endometriosis, but what about people who experience symptoms after menopause?

Can You Have Endometriosis After Menopause?

While the exact cause of endometriosis isn’t known, health professionals do know that estrogen plays a large part in the disease. The tissues of endometriosis respond to the hormone estrogen. After menopause, estrogen levels drop, which typically means no more symptoms of endometriosis. 

So can you have endometriosis after menopause? Yes, the first case of postmenopausal endometriosis was reported in 1942 by Edgar Haydon, a general practitioner. While data isn’t exactly clear, one study suggests that 4% of postmenopausal women still deal with endometriosis. 

What Causes Endometriosis After Menopause?

One reason people may continue to experience endometriosis symptoms after menopause is if they decide to use HRT to help manage symptoms of menopause. Besides managing symptoms, HRT can also help menopausal people to maintain bone health and overall quality of life. For people with a history of endometriosis, the use of estrogen may cause endometriosis symptoms to continue.

It may even be possible for those without a history of endometriosis to develop it after menopause. It’s unclear if these cases are because of new developments or because someone previously went undiagnosed. 

Other medications and treatments used in menopause may contribute to postmenopausal endometriosis. This includes phytoestrogens (plant-based estrogens) and tamoxifen – a selective estrogen receptor modulator. 

Although uncommon, endometriosis has also been found in adolescents who haven’t started menstruating yet. Based on this, it’s fair to say that endometriosis doesn’t just affect people who are in their reproductive years. So how do you manage these often painful and debilitating symptoms?

Diagnosing Endometriosis After Menopause

The first step in treating endometriosis after menopause (or at any stage) is getting a proper diagnosis. Your healthcare provider will take a detailed health history and most likely perform a pelvic exam. Further diagnostic tests and procedures may involve blood tests, a transvaginal ultrasound, MRI, or minimally invasive laparoscopy. 

A proper diagnosis is critical, as symptoms of endometriosis are similar to those of ovarian cancer. The risk of ovarian cancer increases with age, so it’s vital to see a medical provider whether or not you had endometriosis before menopause.

Treating Endometriosis After Menopause

Unlike people who are still menstruating, for postmenopausal women surgery is typically the first treatment providers turn to for endometriosis. Surgery can not only help minimize symptoms but also reduce the risk of cancer in the reproductive organs. Even those who have had a partial or total hysterectomy may continue to experience symptoms of endometriosis. This is especially true for people using estrogen therapy. 

Other options include the use of two different medications – progestogens and aromatase inhibitors. Progestogens mimic the hormone progesterone and can help manage symptoms of endometriosis while also suppressing the growth of further tissues. 

Aromatase inhibitors act on the protein aromatase which is responsible for producing oestrogen. This can help suppress the growth of endometriosis, lower inflammation, and reduce symptoms. The difficulty in using this medication after menopause is that it can increase the risk of osteoporosis. Combining it with calcium and vitamin D supplements as well as bisphosphonate can help reduce the risk of osteoporosis.

There is little research on the effects of hormone therapy on menopausal women with endometriosis. While discontinuing it may help improve symptoms, that’s not the case for everyone. Your healthcare provider can help you weigh the pros and cons of hormone therapy and decide if it’s right for your particular needs.