Endometriosis is a commonly reported reproductive health disorder among female-bodied individuals. According to the World Health Organization (WHO), about 10% of women and girls worldwide are affected by endometriosis. Unfortunately, there isn’t a gender-inclusive statistic available, but the number likely includes other individuals who were assigned female at birth (AFAB).
Symptoms of endometriosis are generally most severe before and during menstruation. It is reasonable to assume that individuals with the disorder would experience relief after reaching menopause and no longer menstruating.
However, this is not the case for everyone. Can individuals still experience symptoms of endometriosis after menopause?
What Is Endometriosis?
Endometriosis is characterized by the growth of tissue similar to the endometrium (the lining of the uterus) in other areas of the abdominal and pelvic cavity. The disease can cause growths in the lining of the pelvis, fallopian tubes, ovaries, and other locations.
These growths lead to chronic inflammation, resulting in the development of scar tissue in affected areas. Individuals with endometriosis may experience symptoms that significantly impact their daily lives, particularly during their menstrual cycle.
Common symptoms of endometriosis include:
- Heavy periods, and possible heavy bleeding between periods
- Abdominal or lower back pain during periods
- Pain during penetration
- Pain while using the bathroom
- Fatigue
- Bloating
- Nausea and vomiting
- Mental health symptoms such as depression and anxiety
- Infertility
The cause of endometriosis is unknown, and while there is no cure, symptoms can be managed to some extent depending on the individual. Symptoms generally subside after menopause, but not always.
Menopause Refresher
Menopause is reached when an individual goes 12 consecutive months without a period. The average age of menopause is 51, and individuals go through perimenopause for an average of four to eight years before fully reaching menopause.
During perimenopause, individuals may experience symptoms such as hot flashes, difficulty sleeping, vaginal dryness, and emotional changes. These symptoms can often be managed with hormone replacement therapy or natural methods such as acupuncture and dietary changes.
While many individuals who have difficult menstrual cycles experience relief after menopause, it signifies the end of uncomfortable symptoms. This is true for many individuals with endometriosis, but what about those who experience symptoms after menopause?
Can You Have Endometriosis After Menopause?
Estrogen plays a significant role in endometriosis, and the tissues of endometriosis respond to the hormone estrogen. After menopause, estrogen levels decrease, which typically means no more symptoms of endometriosis.
So, can you have endometriosis after menopause? Yes, the first case of postmenopausal endometriosis was reported in 1942 by Edgar Haydon, a general practitioner. While exact data is unclear, one study suggests that 4% of postmenopausal women still experience endometriosis.
What Causes Endometriosis After Menopause?
One reason individuals may continue to experience endometriosis symptoms after menopause is if they use hormone replacement therapy (HRT) to manage menopausal symptoms. In addition to symptom management, HRT can also help individuals maintain bone health and overall quality of life. For individuals with a history of endometriosis, the use of estrogen in HRT may cause symptoms to persist.
It may even be possible for those without a history of endometriosis to develop it after menopause. It’s unclear if these cases are due to new developments or because individuals were previously undiagnosed.
Other medications and treatments used in menopause may contribute to postmenopausal endometriosis. This includes phytoestrogens (plant-based estrogens) and tamoxifen – a selective estrogen receptor modulator.
Although uncommon, endometriosis has also been found in adolescents who haven’t started menstruating yet. Based on this, it’s fair to say that endometriosis doesn’t just affect individuals who are in their reproductive years. So, how do you manage these often painful and debilitating symptoms?
Diagnosing Endometriosis After Menopause
The first step in treating endometriosis after menopause (or at any stage) is getting a proper diagnosis. Your healthcare provider will take a detailed health history and most likely perform a pelvic exam. Further diagnostic tests and procedures may involve blood tests, a transvaginal ultrasound, MRI, or minimally invasive laparoscopy.
A proper diagnosis is critical, as symptoms of endometriosis are similar to those of ovarian cancer. The risk of ovarian cancer increases with age, so it’s vital to consult a medical provider whether or not you had endometriosis before menopause.
Treating Endometriosis After Menopause
Unlike individuals who are still menstruating, for postmenopausal women, surgery is typically the first treatment option for endometriosis. Surgery can help minimize symptoms and reduce the risk of cancer in the reproductive organs. Even those who have had a partial or total hysterectomy may continue to experience symptoms of endometriosis, especially if they are using estrogen therapy.
Other options include the use of two different medications – progestogens and aromatase inhibitors. Progestogens mimic the hormone progesterone and can help manage symptoms of endometriosis while suppressing the growth of further tissues. Aromatase inhibitors act on the protein aromatase, which produces estrogen. This can help suppress the growth of endometriosis, lower inflammation, and reduce symptoms. However, using aromatase inhibitors after menopause can increase the risk of osteoporosis. Combining them with calcium and vitamin D supplements as well as bisphosphonate can help reduce the risk of osteoporosis.
There is limited research on the effects of hormone therapy on menopausal women with endometriosis. While discontinuing it may improve symptoms for some, it may not be the case for everyone. Your healthcare provider can help you weigh the pros and cons of hormone therapy and decide if it’s right for your particular needs.
