Endometriosis and Menopause: Understanding and Managing the Condition

Corey Whelan

Written by Corey Whelan

Endometriosis is a common condition that affects around 10% of women during their reproductive years, most often between the ages of 25-40.1 The heavy bleeding, pain with sexual activity and bloating commonly caused by this condition typically stops once women go through menopause, which is why endometriosis and menopause don’t usually go together. However, for a small percentage of women, endometriosis symptoms can either begin or remain after the menopause transition has occurred.

If you think any of the symptoms you’re experiencing may be caused by endometriosis, we encourage you to read on. Below we’ll discuss the frequency and severity of endometriosis after menopause, plus provide solutions for addressing this disease.  

What is Endometriosis?

Endometriosis is a gynecological condition that occurs when tissue typical of the endometrial lining of the uterus, grows outside of the uterus. This tissue responds to cyclical hormonal changes and bleeds or sheds during menstruation, in the same way the uterine lining does. Since it has no way to exit the body, it builds up, causing pain and scar tissue. Some women may even experience the extreme pain and bloating of “endo belly,”2 in addition to heavy periods and severe menstrual cramps. Many women also have lower back pain, and pain during sex. Discomfort or pain during urination and bowel movements when menstruating, is also common.3

Does Endometriosis Go Away After Menopause?

Since endometrial tissue sheds as part of the menstrual cycle, endometriosis, and the symptoms it causes, typically dissipate when your periods stop with menopause. While uncommon, endometriosis after menopause does still occur in approximately 2% to 5% of women.4   

“Endometriosis is fueled by estrogen. Historically, we think about estrogen production stopping after menopause. However, after menopause, the ovaries keep releasing estrogen for about 10 years. The amount of estrogen in your body declines but is not gone completely. For that reason, endometriosis, and the symptoms it causes can persist in postmenopausal women. For women whose weight is in the obese range, this may also be more pronounced,” explains gynecologist Nancy Kimber, M.S., M.D., FACOG. In Dr. Kimber’s practice, 2% to 3% of postmenopausal women have endometriosis, with most of them being diagnosed with this condition before they entered menopause. Some menopausal women diagnosed previously may also continue to struggle with pain caused by a buildup of scar tissue or adhesions even after their periods have stopped.  

Endometriosis can also occur after menopause in women who never had the disease. In those instances, HRT (hormone replacement therapy) may be at cause. HRT can potentially generate new cases of endometriosis and it may also reactivate the disease in some women, however more research needs to be done in order to come to a more significant conclusion regarding this connection.

Women who have been prescribed tamoxifen to reduce breast cancer risk may also experience postmenopausal endometriosis symptoms.6 Tamoxifen is a selective estrogen receptor modulator, which means it works like an anti-estrogen in breast cells, but mimics the effects of estrogen in other tissues, including the uterus.7 

Diagnosis and Treatment of Endometriosis After Menopause

Endometriosis is diagnosed through a minimally invasive surgical procedure called a laparoscopy.8 A small incision is made in the belly, and a tube with a camera at its tip is inserted. Your surgeon can then see and remove most endometriosis lesions during this procedure. Dr. Kimber notes that the severity of this disease does not always correlate with the amount of pain you have. For that reason, your surgeon may find and remove more scar tissue than you suspected was there. If the amount of endometriosis is severe, and causing bladder or bowel symptoms, surgery may be beneficial for removing lesions and scar tissue as well.9,10

According to Dr. Kimber, there is no gold standard of care for treating endometriosis in women after menopause. “Adding back estrogen is likely to exacerbate endometriosis in postmenopausal women who had it before menopause. For that reason, using HRT may not be a good idea for them. Unless there are issues with urination or bowel movements, treatments for endometriosis in postmenopausal women typically center on pain relief,” she explains.

In women of reproductive age, the medications prescribed for endometriosis reduce the amount of estrogen produced by the body. Dr. Kimber explains that treatments can include birth control pills, or gonadotropin releasing hormone (GnRH) agonists, but cautions that these medications may not be appropriate to prescribe for postmenopausal women. “GnRH agonists work on the brain to stop estrogen production, but they can substantially increase the risk of heart disease and osteoporosis, which are more likely to occur in women as they age. Rather than reducing estrogen production, what makes sense for this population, is to focus on symptom relief, especially pain management,” says Dr. Kimber.

Pain relief strategies include taking over-the-counter analgesics, such as Motrin or Advil. Dr. Kimber also recommends acupuncture for pain relief, and physical therapy for tissue adhesion pain management. She also swears by yoga and meditation as viable strategies for reducing pain.

What Happens if Endometriosis is Not Treated After Menopause?

There is no conclusive evidence linking endometriosis after menopause with an increased ovarian cancer risk. However, some healthcare providers recommended the removal of endometrial lesions, to eliminate the risk of a malignancy forming.11 While rare, it makes sense to have a conversation with your healthcare provider about your personal risk.

It also makes sense to talk about symptom relief. If you have unexplained pain, let your provider know. Since you no longer have periods, you may be more likely to experience endometriosis pain during sex, urination, or bowel movements. No matter what’s causing pain, your healthcare provider can help to explain it and work with you to alleviate it.    

Resources

  1. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis#:~:text=Endometriosis%20is%20a%20common%20gynecological,American%20women%20of%20childbearing%20age.
  2. https://www.medicalnewstoday.com/articles/endo-belly
  3. https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis#:~:text=Endometriosis%20is%20a%20common%20gynecological,American%20women%20of%20childbearing%20age.
  4. https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-3-135#:~:text=The%20prevalence%20of%20pelvic%20endometriosis,to%205%25%20of%20postmenopausal%20women.
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151055/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151055/
  7. https://www.cancer.org/cancer/breast-cancer/treatment/hormone-therapy-for-breast-cancer.html#:~:text=Tamoxifen,selective%20estrogen%20receptor%20modulator%20(SERM)
  8. https://www.healthline.com/health/endometriosis/laparoscopy-for-endometriosis
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229526/.
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293388/#:~:text=Partial%20cystectomy%20%E2%80%93%20especially%20by%20laparoscopic,bladder%20wall%20affected%20by%20endometriosis.
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151055/ 

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