Endometriosis After Menopause: What to Know

Endometriosis is a health condition where tissue similar to the lining of your uterus builds up on organs outside the uterus. This tissue responds to hormones just like the lining of your uterus does. It builds up and breaks down each month — only it can’t flow out of your body through the vagina. As a result, it may cause a lot of pain, heavy bleeding, and fertility problems, among other symptoms.

It might seem logical that when your periods stop, endometriosis would also stop. That’s not always the case. In 2 to 5 percent of cases, endometriosis continues after menopause. It’s rare, but it happens.

If you have endometriosis after menopause, it’s important to consider your treatment options. Leaving it untreated has some health risks.

In this article, we look at the potential causes of endometriosis after menopause, along with diagnosis, potential complications, and treatment options.

Endometriosis after menopause is more likely if you’ve been diagnosed with the condition earlier in life. Still, endometriosis can start after your periods end. In fact, it sometimes begins as many as 10 years later.

Researchers think the growth of these uterus-like cells could be “switched on” by something in your genetic background or something in your environment that affects your genes.

Often, women discover they have endometriosis when they see a doctor because they have symptoms such as:

• increasing pelvic pain
• pain when having a bowel movement
• pain when urinating
• constipation

During menopause, your body produces much less of the hormone estrogen. Most of the time, that means the symptoms of endometriosis lessen. They may even resolve completely. That’s because this type of tissue usually needs estrogen to grow. But for a small number of women, endometriosis continues after menopause. If you had severe endometriosis before your periods stopped, you’re more likely to have symptoms afterward.

If you take hormone replacement therapy (HRT) to help with the symptoms of menopause or to reduce your risk of bone loss and heart disease, the hormones in HRT may “re-activate” your endometriosis.

More research needs to be done to understand the risks involved for women with endometriosis who want to use HRT during menopause. It’s important to discuss the risks and possible rewards with a healthcare professional as you consider your options.

To find out whether you have endometriosis, a medical professional can use several tools, including:

• Pelvic exam. This exam allows your healthcare professional to feel any growths or scar tissue that may have formed because of endometriosis
• Ultrasound. An abdominal ultrasound uses sound waves to create pictures of cysts that may have formed in your pelvis.
• Computed tomography (CT). A CT scan uses rotating X-rays to detect changes in the shape of the organs in your abdomen.
• Magnetic resonance imaging (MRI). An MRI uses a magnetic field to create detailed pictures of any places where endometrial tissue has implanted in your abdomen.
• Laparoscopy. During this procedure, a surgeon makes a small cut near your belly button and inserts a tiny camera that shows where endometrial tissue is located in your abdomen.

Many health experts say the best option for endometriosis in menopause is to surgically remove the areas of endometrial tissue (called “implants”). That way there’s less risk that they could later become cancerous and less chance they’ll continue to cause other health problems.

It’s important to understand that surgery won’t necessarily cure the condition, though. There’s a possibility it could recur later.

If surgery isn’t a good option for you, your doctor might prescribe:

These treatments can help with pain and help slow the growth of implants.

It’s important to treat endometriosis that happens after menopause. There’s some evidence that the condition can continue to spread to other areas in the abdomen. In some cases, it can block the bowel or urinary tract.

Untreated endometriosis after menopause can also raise your risk of cancer.

Research shows that about 1 to 3 percent of those with the condition develop cancer in areas where they have endometriosis. Your risk may be slightly higher if you use hormone replacement therapy (HRT).

Endometriosis doesn’t necessarily end when you’re in menopause. In fact, the condition can develop years after your periods stop.

Many of the symptoms are the same before and after menopause, including:

• pain
• inflammation
• constipation
• urinary issues

To confirm that the symptoms are related to endometriosis, you may need a pelvic exam, imaging tests, or laparoscopy. Treatment could include surgical removal of affected areas, medications to help with pain, or both.

An accurate diagnosis and treatment can ease your symptoms and lower the risk that the condition will spread or become cancerous. If you’re having symptoms that could be endometriosis, talk to a medical professional sooner rather than later.