Endometriosis in Menopause: Expert Guidance & Insights

What Would Happen to the Signs and Symptoms of Endometriosis After Menopause?

There is still much unknown about endometriosis after menopause. Some studies have shown that the severity of symptoms may lessen with age, while others have found that endometriosis can worsen after menopause, especially when adenomyosis of the uterus persists for decades into the menopausal years. For many, managing symptoms becomes a lifelong process. If you experience pelvic pain or intestinal symptoms near or after menopause that may be related to endometriosis, it’s important to talk to your doctor about options for accurate diagnosis and treatment.

Managing Endometriosis During Menopause

Whether symptoms reflect ongoing disease or the effects of prior treatment, scarring is one of the normal processes the body uses to heal. Persistent active endometriosis or adenomyosis, as well as scars or fibrosis affecting various organs and the peritoneum, can cause ongoing symptoms. Even without taking estrogen replacement and with a known history of endometriosis, estrogen still exists in the body in varying amounts because fat cells convert other hormones or toxins into estrogen. The amount of estrogen required to drive endometriosis growth varies between individuals, and estrogen is not the only molecular driver behind endometriosis. For these reasons, pain from endometriosis persists into menopause in at least 2–5% of patients. Treatment approaches overlap regardless of why symptoms are present, but they are not exactly the same for every situation.

Reducing the Severity of Endometriosis Symptoms During Menopause

Surgery remains part of the discussion because accurate blood-test biomarkers are still not available. Whether symptoms are due to persistent or newly developing endometriosis, scarring from endometriosis healing, or progressive scarring from prior excisions, expert evaluation for possible surgical intervention should be a cornerstone of planning. A risk–benefit discussion with an experienced surgeon helps determine what is going on after menopause and can guide a tailored plan that may involve excision of endometriosis, treatment of scar tissue, or even possible hysterectomy. If persistent adenomyosis is the cause of pain, surgery may be the most effective option to eliminate symptoms.

If active endometriosis is responsible, symptom severity may be reduced through general adjustments that include diet and lifestyle modifications. Reducing stress with calming activities such as yoga or meditation, eating an anti-inflammatory diet high in fiber to help absorb excess estrogen in the gut, and engaging in regular physical activity can help ease endometriosis pain for some. These recommendations depend on what else may be going on, such as small intestinal bacterial overgrowth (SIBO) or irritable bowel syndromes.

The following are some specific considerations.

Taking Hormone Replacement Therapy (HRT)

Taking hormone replacement therapy (HRT) is an important treatment decision. HRT uses hormones to relieve menopausal symptoms. If the uterus is still present, both estrogen and progesterone are required to reduce the risk of uterine cancer. If not, estrogen replacement therapy (ERT) alone may be better because it is associated with a lower risk of developing breast cancer. It remains controversial whether HRT or ERT can make endometriosis grow; available scientific data suggest that HRT may be preferable in this regard, but the issue is not clear-cut. It is also unclear whether herbal or plant-based estrogen replacement is safe, and based on complex molecular biology factors, the effects are probably different for each individual. The body is never in a zero-estrogen state because fat cells convert other hormones into estrogen, and toxins encountered in daily life (xenoestrogens) can also play a role.

Taking Pain Relievers Like Ibuprofen or Acetaminophen

Over-the-counter pain relievers such as ibuprofen or acetaminophen may be effective for intermittent mild to moderate endometriosis pain. Side effects are usually mild but should be weighed against the benefits of longer-term use. A pain specialist may recommend stronger medications such as narcotics, gabapentin, or related drugs, but continuous use is generally not recommended. Relying solely on pain medications is like putting a bandage on a significant wound without repairing the underlying problem. A better strategy is to identify and address the root cause. Determining whether pain in menopause is endometriosis- or adenomyosis-related may require expert evaluation, and this topic has been explored in the literature.

Reducing Stress with Relaxation Techniques like Yoga or Meditation

Yoga and meditation have been shown to effectively reduce stress levels, which may lessen endometriosis-related symptoms. The mechanisms are not fully understood but may involve alterations in cortisol levels or epigenetic regulation of gene expression related to pain receptors. This area is subjective and challenging to study objectively, and research is ongoing. Because these practices carry minimal risk and can benefit overall health in multiple ways, they are reasonable options to consider.

Exercising Regularly

Regular exercise supports physical and mental health at any age. For people with endometriosis, physical activity can help reduce inflammation and modulate the body’s response to pain. Studies indicate that consistent workouts may help manage endocrine problems, anxiety, and stress levels. Exercise is also associated with improved sleep quality, making it a low-risk lifestyle modification with multiple potential benefits.

Pelvic Floor Therapy

Inflammation from endometriosis and/or direct nerve impingement at the pelvic floor can cause pain in menopause, similar to what many experience during the reproductive years. The muscles and fascia may overreact and spasm, and pelvic floor physical therapy can be used to address these issues. In some cases, this approach helps with fibrosis or scar-related pain by restoring normal motion. Typically, it requires a structured program rather than a single session, so a consultation with a pelvic floor therapist is worth considering. Pelvic floor therapy may or may not be the solution for a given individual; if pain persists, surgical options may still need to be considered to reach the root of the problem.

Don’t Suffer with Prolonged Severe Symptoms

After menopause, many people find that endometriosis and related symptoms still significantly affect daily life, even with prudent diet and lifestyle modifications. If this describes your situation, speak with an expert about the potential benefits and risks of surgery and other available treatments. Molecular markers for endometriosis may be on the horizon, but today surgery is the only way to accurately diagnose endometriosis. Especially when pain persists into menopause (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151055/) or begins during menopause, other conditions may be responsible, or endometriosis may overlap with adenomyosis. Surgical treatment may or may not be the right answer, but expert guidance and a complete evaluation are preferable to waiting and hoping the pain will resolve on its own.