Endometriosis after Menopause: Here’s What You Need to Know

Did you know it can take a woman about ten years to receive an endometriosis diagnosis?

It’s a statistic often used to emphasize the gap in treatment for and lack of available research about endometriosis, but the number represents the tip of the iceberg. Below it lies overlooked women’s health concerns (often about menstrual cycle-related pain) and misconceptions about the function of our hormones and reproductive system.

So in 1993, the Endometriosis Association declared the entirety of March Endometriosis Awareness Month. The goal was to spotlight the painful symptoms and delayed diagnoses up to 10% of women face and advocate for more education about this common women’s health condition.

However, endometriosis research tends to focus on younger and middle-aged women during childbearing years as it’s an “estrogen-dependent” condition.” This focus can leave women wondering:

If estrogen levels start to decline during perimenopause, does that mean endometriosis eventually goes away, or does it stick around postmenopause?

Here’s what you need to know about endometriosis during perimenopause and after menopause.

What is endometriosis?

Endometriosis describes when tissue similar (not the same) to the inside layer of your uterus grows outside and around the uterus, such as on your ovaries, vagina, and bladder. Unlike your uterine lining, endometrial tissue doesn’t have anywhere to go during your monthly cycle, which can lead to inflammation, swelling, and the development of scar tissue.

Common endometriosis symptoms include cramping and lower back pain before or during your period, during intercourse, or when you urinate. Some women also experience spotting, bloating, or problems with their digestion.

Endometriosis has no known cause (but many theories about its origins), which can explain the delay between initial symptoms and a formal diagnosis.

How does perimenopause impact women with endometriosis?

Perimenopause marks when you experience fluctuating hormones as your ovaries become less active, signaling you’re approaching menopause. Menopause occurs when you’ve been without a period for twelve months—an event women often mark after entering postmenopause.

During the first half of perimenopause, which can last about four or more years, your hormone levels (including estrogen) rise and fall unpredictably, worsening endometriosis symptoms. As the time between your periods lengthens during the latter half of perimenopause, you may notice endometriosis symptoms subside as your estrogen levels steadily decline.

Once you’re in postmenopause, the likelihood of continued endometriosis symptoms is rare—but not impossible. Most women experience a resolution of endometriosis symptoms after menopause.

But estrogen does not disappear from your body once you enter postmenopause, so it’s possible to experience recurring (though often milder) endometriosis symptoms. Or, as researchers note, endometriosis may “reactivate” in women who take hormonal medications after menopause that increase the amount of estrogen in the body.

What is postmenopausal endometriosis?

Then we come upon an entirely new category: postmenopausal endometriosis. A new (or “de novo”) diagnosis of endometriosis after menopause affects about 2-5% of women and is more challenging to diagnose than pre-menopausal endometriosis.

Symptoms of endometriosis postmenopause are similar to symptoms before the menopause transition and often include pelvic pain and digestive issues. Endometriosis symptoms after menopause can even mimic specific perimenopausal symptoms such as hot flashes, and some women experience no symptoms at all.

At the moment, working theories about the origins of postmenopausal endometriosis include:

• Some postmenopausal women have increased sensitivity to estrogen after menopause
• Some women are genetically disposed to endometriosis after menopause
• Some forms of endometriosis can grow without estrogen

However, researchers continue to investigate whether these diagnoses of postmenopausal endometriosis indicate a brand-new condition or if they can classify these cases as previously undiagnosed or reactivated endometriosis.

How do you get a diagnosis for endometriosis before and after menopause?

These theories about postmenopausal endometriosis lead us to a critical question and a catalyst for Endometriosis Awareness Month: How do you get diagnosed with endometriosis sooner rather than ten years later?

Your first course of action, whether in perimenopause or postmenopause, is to bring up your concerns and ongoing symptoms with your doctor. First, your doctor may perform a pelvic exam to see if you have any noticeable cysts or scarring. Your doctor may also order an ultrasound or other imaging (like an MRI) for a clearer picture of your organs and any present endometrial tissue.

As of today, there’s no definitive external biomarker (e.g., body temperature, blood pressure) that indicates the presence of endometriosis. The only way to know for sure whether you have endometriosis (before or after menopause) is through a laparoscopy: a minor surgery that allows your doctor to insert a small camera into your pelvic area to check for endometriosis.

Treatments for endometriosis during perimenopause and after menopause

Women who receive an endometriosis diagnosis must often choose between ongoing pain management or pursuing surgical options to remove any build-up of endometrial tissue, cysts, or scarring.

There are no cures or preventative measures for endometriosis, though medical professionals often recommend following stress-management practices, eating a healthy diet, and getting plenty of sleep to reduce symptoms. Some studies also suggest vaginal moisturizers can help women find relief if their endometriosis symptoms are similar to perimenopause symptoms.

For postmenopausal women with suspected new or recurring endometriosis, it’s always a good idea to speak with your doctor about the best diagnostic and treatment options for you based on your medical history and any pre-existing conditions.

Endometriosis impacts day-to-day activities and responsibilities for women of any age. We’re glad to witness a resurgence of interest in the root causes and treatment of endometriosis, but we’ve got a ways to go.

Awareness and education about endometriosis are vital. The more we push forward conversations about women’s health conditions like endometriosis, the more research, education, and treatment options will emerge to help more women live full and healthy lives.

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FemmePharma has been helping women navigate menopause for over two decades. No matter where you are in your journey, you deserve to have knowledgeable, intimate healthcare partners to help you feel your best. Explore our other articles, podcast episodes with women’s health experts, and products to ease your transition into menopause.

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