Does Endometriosis Go Away After Menopause?

Endometriosis is a painful condition that impacts 6.5 million women in the U.S. Unfortunately, it’s also one of the most underresearched and underdiagnosed conditions, despite the fact that it impacts 10% of women of reproductive age worldwide. (Yes, you read that correctly.) In recent years, we’ve made some strides in the women’s health space when it comes to the conversation around endometriosis, but major gaps in information persist, such as how it is influenced by menopause. We’re breaking down what we know based on where the science lies now.

What is endometriosis?

Endometriosis is a condition where endometrial tissue, a type of tissue similar to the lining of the uterus, grows outside of the uterus. It can also affect other areas of the reproductive system such as the ovaries, fallopian tubes, bowel, and bladder. During the menstrual cycle, these tissues swell and bleed, which can cause more severe cramping and pain. Unlike uterine lining, however, endometrium isn’t expelled with a period, which can lead to painful scar tissue buildup over time. Symptoms of endometriosis can include:

• Painful cramping before and sometimes during periods
• Pain during and after sex
• Chronic pelvic pain and/or low back pain
• Pain with urination and bowel movements
• Bloating and/or constipation

In some cases, endometriosis can also cause bleeding between periods, and infertility.

While the immediate symptoms of endometriosis involve physical pain, we can’t discount the emotional side effects that can accompany a life of potentially chronic pain, not to mention the strain on romantic relationships.

What causes endometriosis?

As we mentioned earlier, there’s unfortunately still a lot of unknowns around endometriosis, including how exactly it’s caused. What we do know is women who have a family history of endometriosis are at increased risk for developing the condition.

How is endometriosis diagnosed?

Endometriosis is typically diagnosed through a minimally invasive surgical procedure called a laparoscopy. This involves the insertion of a small camera through an incision in the belly, allowing the surgeon to see if endometrial cells are present. If the surgeon finds adhesions, they will remove them during the procedure and may send tissue to a lab for biopsy to rule out malignancy. Providers may sometimes use imaging tests like ultrasound and MRI as additional tools to diagnose endometriosis.

Endometriosis in menopause

During early perimenopause, estrogen and progesterone begin to fluctuate dramatically, which can lead to heavier and more frequent periods (and a slough of other symptoms most of us are all too familiar with). Because endometriosis is estrogen-dependent, these hormonal changes and resulting irregular periods can mean more severe symptoms.

The good news (finally!) is that for many women, endometriosis symptoms stop after natural menopause, a moment of time marked by a year without a menstrual cycle. This is due to estrogen/oestrogen levels stabilizing.

Can I get endometriosis after menopause?

While uncommon, it is possible to develop endometriosis after menopause, with the condition affecting 2-5% of postmenopausal women, even though menstruation has stopped. When the condition does appear after menopause, it’s important that the lesions be biopsied for malignancy.

Treatment options for endometriosis

Premenopausal endometriosis

For pre- and perimenopausal women, endometriosis treatment typically begins with medication, which can include one or a combination of the following…

• Hormonal contraceptives to stabilize the hormones that stimulate endometriosis
• Pain medicines to ease the painful symptoms of endometriosis
• Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists to stop periods and suppress related symptoms

If medication alone does not help with symptoms, a clinician may recommend surgery to remove the lesions, or, in severe cases, hysterectomy.

Postmenopausal endometriosis

For postmenopausal patients with endometriosis, surgical removal of endometrial tissue is usually considered the first line of defense, as opposed to medication.

However, some emerging research suggests that aromatase inhibitors, a class of medicines used to treat breast cancer in postmenopausal women, may be effective in treating postmenopausal endometriosis. The medication works by lowering the amount of estrogen in the body, and thus suppressing growth of endometrial tissue. At this time, the treatment is still experimental, but we’re hopeful that it may be a future alternative to surgery.

Can you take hormone therapy if you have endometriosis?

Menopausal hormone therapy (previously referred to as hormone replacement therapy or HRT) is often used to treat symptoms of menopause such as hot flashes/night sweats, low libido, and vaginal dryness to name a few.

Due to the relationship between endometriosis and estrogen, treatment through MHT requires a highly individualized approach—but that doesn’t mean it’s off the table. In some cases, there may be a risk of endometriosis symptom recurrence, but this can often be controlled through mindful dosing.

A qualified provider, such as one of Elektra’s certified, menopause-trained clinicians will work with patients to assess the potential benefits and risks of hormone therapy.

The bottom line

Endometriosis is a common, often painful condition that mainly impacts women of reproductive age, but can occur in postmenopausal women. And while it’s true that symptoms can have a real bearing on quality of life, especially when compounded with additional symptoms of menopause, there are treatment options available. If you’re struggling with consistent pelvic pain or long and heavy periods, don’t hesitate to contact a healthcare provider.

READ MORE:

• Navigating Life After Surgical Menopause: What To Know & How To Prepare
• 6 Signs of Pelvic Floor Dysfunction in Perimenopause
• How to Advocate for Yourself at the Doctor’s