Menopause and endometriosis share certain similarities but are fundamentally different. Menopause is a natural transition that occurs for every woman, while endometriosis is a chronic, and often painful, inflammatory health condition in which abnormal tissue growth occurs outside of the uterus. However, some women with the disease may notice changes in symptoms of endometriosis after menopause.
Healthy uterine tissue gets discharged from the body when a woman gets her period. However, in cases of endometriosis, this uterine-like tissue remains in the body during menstruation. Eventually, scar tissue and lesions may develop. In addition to the outside of the uterus, abnormal tissue growth can also affect the ovaries, cervix, vagina, bladder, bowel, or rectum. While rare, endometriosis can also develop in the lungs or brain.(1)(2)
Endometriosis affects approximately 10% of women of reproductive age worldwide.(1) In rare instances, postmenopausal women may also experience symptoms, a condition known as postmenopausal endometriosis. It’s estimated to affect between 2% and 4% of postmenopausal women.(3)(4) This article will explore how hormonal changes may affect symptoms of endometriosis after menopause and discuss different treatment methods to help manage the discomfort.
The Relationship Between Menopause and Endometriosis
The exact cause of endometriosis, including postmenopausal endometriosis, is not currently known. However, estrogen is known to play a key role in both menopause and endometriosis.
Because higher levels of estrogen are associated with cases of endometriosis in women of reproductive age, most women experience a reduction in symptoms as estrogen levels fluctuate and drop throughout different stages of menopause. However, menopause does not cure endometriosis, and some women may experience an increase in endometriosis symptoms after menopause.(4)
Menopause is characterized by a period of estrogen deficiency. Therefore, the underlying mechanisms of postmenopausal endometriosis may be different from those of cases that develop during a woman’s reproductive years. Although the decline in ovarian function that occurs during menopause significantly lowers women’s estrogen levels, the body continues to produce small amounts of estrogen in fatty tissues and the skin. The use of hormone replacement therapy (HRT) to replenish levels of estrogen in the body has also been linked to cases of endometriosis in menopausal and postmenopausal women. Researchers suggest that these alternative sources of estrogen may contribute to the development of postmenopausal endometriosis.(4)(5)
What happens to endometriosis after menopause?
Endometriosis can develop as early as a woman’s first period, and those with the condition may continue to experience symptoms after menopause. Women who have a history of endometriosis symptoms during their reproductive years, signs of prior endometriosis, or obesity may be at an increased risk for the condition continuing during or after menopause.(4)
For some women, new endometriotic lesions may develop during this phase of life. For others, existing asymptomatic lesions may become symptomatic. Research shows that postmenopausal endometriosis pain associated with lesions has been documented in women up to 80 years old. In comparison, some postmenopausal women may have lesions but not experience any symptoms. Most cases of postmenopausal endometriosis affect the ovaries.(4)(5)
Symptoms of Endometriosis After Menopause
Some women may experience the following non-specific symptoms of endometriosis after menopause:(3)(4)(5)
Persistent or recurrent pelvic pain
Pain during sex
Intestinal pain
Ovarian cysts
Urinary or bowel symptoms
Abnormal bleeding (including vaginal or rectal bleeding)
Blood in the urine
Some symptoms of postmenopausal endometriosis may resemble certain menopause symptoms, including painful sex, low libido, or irregular bleeding, particularly during perimenopause. However, additional symptoms like hot flashes or night sweats are considered more specific to menopause than endometriosis.
Treatment Options for Postmenopausal Endometriosis
Because there’s no known cure for endometriosis, treatment primarily focuses on symptom management. While more research is needed on treatments specific to postmenopausal women, a doctor may recommend the following treatment options for women experiencing symptoms of endometriosis after menopause:(2)(4)(5)(6)
Surgery: A surgeon will remove all visible endometriotic lesions. Surgery is the primary treatment method for symptomatic postmenopausal women to reduce the risk of endometriosis recurrence and cancer.
Progesterone Treatment: Oral progesterone medication or a hormonal intrauterine device may be recommended for postmenopausal endometriosis treatment if a patient is unable to undergo surgery.
Aromatase Inhibitors (AIs): These prescription medications suppress estrogen production in the body. They also block aromatase activity within endometriotic lesions, an enzyme that promotes the conversion of androgens into estrogens. While scientific evidence is limited, these drugs may help decrease the size of lesions and reduce endometriosis symptoms in postmenopausal women who have undergone natural menopause or surgical menopause. However, AIs may produce side effects, including vasomotor symptoms, vaginal dryness, and bone loss.
Over-the-Counter (OTC) Pain-Relief Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naprosyn, may be used to treat mild to moderate pain symptoms as needed.
Endometriosis can significantly impact women’s quality of life, and there’s still much to learn about cases that develop later in life. While symptoms often improve with age, women should continue monitoring for symptoms of endometriosis after menopause. The condition has been linked to other health issues, including autoimmune diseases, fibromyalgia, and certain cancers.(2) Therefore, it’s important to consult with a healthcare provider to determine the underlying cause of symptoms and appropriate treatment methods.
