Endometriosis After Menopause: What You Need to Know

Living with endometriosis is difficult at any age—but if you’re approaching or have already reached menopause, you may be shocked to find your symptoms persisting, changing, or even showing up for the first time. For years, you may have heard that endometriosis would "burn out" after menopause. Unfortunately, that’s not always true, and persistent pain, digestive troubles, or pelvic discomfort can still haunt women well into their fifties and beyond.

The reality is that endometriosis can stay active or even begin after menopause. The symptoms aren’t always obvious, and the way most doctors understand, screen and treat endometriosis in older women brings new challenges. Recent research is shining more light on what you can expect—and how you can get the care you deserve.

Endometriosis Isn’t Just a Young Woman’s Disease

Many people (including most doctors) still believe endometriosis only affects younger women who menstruate. This assumption is not only outdated, it can delay getting diagnosed and treated. If you’re peri-menopausal (around the time your period starts to change or stop) or post-menopausal and you’re experiencing pain, bloating, urinary or bowel symptoms, or even unexplained bleeding, these could still be signs of endometriosis—even if your cycle ended long ago.

Endometriosis can:

• Persist after menopause, even if it was diagnosed years earlier
• First appear during peri-menopause or even after periods have stopped (though this is less common)
• Be influenced by hormonal replacement therapy AND can even make its own estrogen locally near the lesions.

The upshot: If you have a history of endometriosis, or unexplained pelvic pain as you age, don’t assume it’s impossible—it could still be endometriosis.

How Symptoms Change With Age

Unlike pre-menopausal women, you may not notice the classic "cyclical" pain tied to your period. Instead, the symptoms in peri- and post-menopausal women are often more vague and misleading:

• Ongoing pelvic pain (not tied to menstruation)
• Bloating or changes in bowel habits
• Pressure or discomfort during intercourse
• Painful urination or urinary urgency
• Sometimes, bleeding after menopause

These symptoms can mimic irritable bowel syndrome, bladder problems, or even gynecologic cancers. That’s why it’s so important to mention your history of endometriosis and keep pushing for answers if the cause of your pain isn’t clear.

Do Hormone Therapies Make Endometriosis Worse After Menopause?

Hormone replacement therapy (HRT) can be a lifeline for some women struggling with hot flashes, night sweats, or vaginal dryness after menopause. However, if you have a history of endometriosis, you need to have a careful discussion with your doctor about risks and benefits.

Here’s what the evidence says:

• Estrogen, even in small amounts, can sometimes "wake up" dormant endometriosis tissue. This means pain can return, old lesions can get worse, or (rarely) new ones can appear.
• There is also a small increased risk that endometriosis tissue could develop into cancer after many years of estrogen exposure—especially if you have a long history of severe disease.
• Using a combination of estrogen and a progestogen (HRT), or opting for non-hormonal treatments, may help balance these risks.
• Using estrogen alone (ERT) can increase the risk of uterine cancer if a hysterectomy has not been performed at some point.
• Using estrogen alone (ERT) does not increase risk of breast cancer in most cases but using HRT (especially with a synthetic progestogen) can.

The decision to use HRT or ERT is deeply personal and is not straightforward. If you’re considering it, or are already using it, make sure your doctor knows about your endometriosis history so you can be started on the best option (ERT vs HRT and synthetic vs bio-identical compounded) and monitored more closely for any signs of trouble.

What Does Treatment and Follow-Up Look Like?

Treatment for endometriosis in your later years is all about individualizing your care. There’s no one-size-fits-all approach. Depending on your symptoms, your history, and whether you’re taking hormones, options may include:

• Pain management: This could involve medications, pelvic floor therapy, or sometimes surgery if big endometriosis cysts or masses are causing trouble.
• Hormone choices: If you need HRT, your provider should talk to you about types, doses, and whether to use estrogen alone or combined with a progestogen (natural or synthetic).
• Regular check-ups: You may need ultrasounds or pelvic exams every year or so, especially if you have symptoms or take HRT.

Be aware that some symptoms—like sudden increases in pain, or bleeding after menopause—should always be checked out promptly to rule out more serious problems.

Practical Takeaways

Bringing up endometriosis after menopause can feel frustrating, especially if your symptoms are being dismissed. Here’s how you can take charge of your health:

Questions to ask your doctor:

1. Could my symptoms still be due to endometriosis, even after menopause?
2. Is HRT or ERT safe for me, and how will we monitor for possible problems?
3. Should I have imaging (like ultrasound or MRI) or other follow-up for pelvic symptoms?
4. What warning signs should I watch for that mean I need urgent care?
5. Are there non-hormonal alternatives to manage my menopause symptoms? (spoiler alert = yes there are)

What to watch for: Any new or worsening pelvic pain, abdominal or vaginal bleeding, bloating, or changes in bowel/bladder habits.

Timeline: If you start or change HRT or ERT, expect any effects on endometriosis to show up within a few months. Ongoing check-ups—even years after menopause—are smart if you have a history of the disease.

Reality Check: What We Still Don’t Know

Endometriosis after menopause is less common, and many doctors are still catching up with the latest evidence. While there is a risk that estrogen exposure could reactivate endometriosis or very rarely lead to cancer, this doesn’t mean everyone is at high risk. Your own history, symptom pattern, and hormone use all matter.

You and your doctor will need to balance relief of menopause symptoms with the potential for reactivating endometriosis—there’s no universal rule. And if you’ve had surgery to remove your uterus and ovaries in the past, your risks and options may look different still.

If your current provider brushes off your pain or ignores your history, it may be worth seeking out an endometriosis expert who is familiar with endometriosis in older women.

Endometriosis is a lifelong condition for many, and you deserve attentive, knowledgeable care no matter your age.