Endometriosis After Menopause: Does It Always Go Away?

Endometriosis is tissue similar to the uterine lining growing outside the uterus, and it’s driven by estrogen. Our guide to what endometriosis is covers the basics. Because estrogen falls at menopause, many women expect it to fade away. For many, pain does ease. But it isn’t always that simple.

It can persist, or start, after menopause

A study of 1,100 women with surgically confirmed endometriosis found 184 diagnosed around perimenopause (ages 45 to 54) and 46 after menopause (ages 55 to 80).¹ The average age at diagnosis in the older group was about 61.¹ The authors called postmenopausal endometriosis an underrecognized condition.¹

They also found:¹

• More advanced disease in the perimenopausal group
• Adenomyosis (endometrial tissue in the uterine wall) was more common after menopause

Our guide to adenomyosis explains that condition.

The ovarian cancer question

Endometriosis has been linked to certain ovarian cancers, so the authors urged clinicians to stay alert in women around and after menopause.¹ Overall risk for any one woman remains low, but new pelvic symptoms deserve attention.

Hormone therapy and endometriosis

If you have endometriosis and hot flashes, you may wonder whether hormone therapy is safe. A large study compared about 10,300 postmenopausal women with endometriosis who used hormone therapy with 10,300 who didn’t.²

• Ovarian cancer was uncommon in both groups: 0.3% with hormone therapy and 0.5% without.²
• Combined estrogen plus progestogen and tibolone weren’t linked to higher ovarian cancer risk.²
• Estrogen alone was linked to a higher risk.²

The authors noted that how hormone therapy affects endometriosis after menopause is still not fully clear.² Given this finding, ask whether your regimen should include a progestogen, even if you’ve had a hysterectomy.

Questions to ask

1. Could my pelvic pain still be endometriosis, even after menopause?
2. If I take hormone therapy, should it include a progestogen?
3. What symptoms should prompt imaging or a recheck?

Our guides to imaging versus laparoscopy for endometriosis, ovarian cancer symptoms and screening and hormone therapy after hysterectomy explain related decisions.

Try: “I had endometriosis for years and had a hysterectomy. Now I want hormone therapy for hot flashes. Should mine include a progestogen?”

Period, Handled includes a Period Scorecard and a visit script. Use them to track pain patterns and treatments, even after your periods have stopped. See the book.