Endometriosis and Menopause: What You Need To Know

Reviewed by Dr. Kenneth Barron, MD

Endometriosis is a chronic condition in which tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This tissue responds to hormonal changes during the menstrual cycle, often leading to pain, inflammation, and the formation of scar tissue. Endometriosis most commonly affects the ovaries, fallopian tubes, and the tissues lining the pelvis, and it can significantly impact a person’s quality of life.  We know this well at the, as treating endometriosis is what we do everyday at the Center for Advanced Gynecology in Charlottesville.

Menopause marks the end of a woman’s reproductive years and typically occurs in the late 40s or early 50s. It is defined as the point when menstrual periods have stopped for 12 consecutive months, signaling a natural decline in reproductive hormones, especially estrogen and progesterone. Many people assume that menopause brings an end to all hormone-related conditions, including endometriosis, but the reality is more complex.

Understanding the connection between endometriosis and menopause is crucial for those who have lived with this condition. While symptoms most often improve as estrogen levels decline, some individuals may continue to experience pain or complications even after menopause. In certain cases, endometriosis can persist or emerge post-menopause, especially in those using hormone replacement therapy (HRT). At The Center for Advanced Gynecology, where we specialize in both surgical and non-surgical management of pelvic pain and endometriosis, we understand the complexities that can arise during this life stage. For those searching for experienced gynecologists Charlottesville patients can trust, our team is dedicated to providing expert care. This article explores how endometriosis behaves during and after menopause, what symptoms to watch for, and what treatment options are available.

Understanding Endometriosis

What is Endometriosis?

Endometriosis is a medical condition where tissue similar to the endometrium—the inner lining of the uterus—grows outside the uterus. Unlike normal endometrial tissue that exits the body during menstruation, this misplaced tissue has no way to leave the body. As a result, it causes inflammation that can lead to scar tissue, new blood vessels, new nerves, and adhesions--where organs stick to each other. The most common areas affected include the ovaries and the tissue lining the pelvis(peritoneum), but we also often see involvement of the intestines, the appendix, the bladder and the diaphragm.

Common Symptoms

The symptoms of endometriosis can vary widely from person to person. Some individuals experience severe symptoms, while others may have little to no noticeable signs. The most common symptoms include:

• Persistent pelvic pain, especially during menstruation (dysmenorrhea)
• Heavy or irregular menstrual bleeding
• Pain during intercourse
• Pain during bowel movements or urination, especially during menstruation
• Infertility or difficulty becoming pregnant
• Fatigue, bloating, and digestive issues such as diarrhea or constipation

These symptoms can sometimes be mistaken for other conditions like irritable bowel syndrome (IBS) or pelvic inflammatory disease, making diagnosis challenging.

How Endometriosis Is Influenced by Estrogen

Endometriosis is a hormone-sensitive condition, primarily stimulated by estrogen, just like the endometrium lining the uterus. Estrogen stimulates the growth and activity of endometrial-like tissue, even when it exists outside the uterus. This is why symptoms often worsen during times of high estrogen production, such as between ovulation and menstruation in reproductive years.

Treatments that lower estrogen levels—like hormonal contraceptives or medications that suppress ovarian function—are often used to manage symptoms. This hormone dependency also explains why many women experience symptom relief with pregnancy and after menopause, when estrogen levels naturally decline. However, in some cases estrogen exposure may continue to fuel endometriotic growth even after menopause.

What Happens to Endometriosis During Menopause?

The Role of Declining Estrogen Levels

Estrogen plays a key role in the growth and activity of endometriosis lesions. During menopause, the ovaries gradually produce less estrogen, which typically results in the thinning of endometrial tissue and the eventual end of the menstrual cycle. Because endometriosis is estrogen-dependent, many women experience a natural decline in symptoms once they reach menopause. The decreased hormone levels can slow or even stop the progression of the condition, leading to relief from chronic pain and inflammation for many individuals.

Does Endometriosis Go Away After Menopause?

While many assume that menopause cures endometriosis, the reality is more nuanced. For most women, endometriosis symptoms do improve or even disappear completely due to the drop in estrogen levels. However, endometriosis does not always go away entirely. In certain cases, lesions can remain active or continue to cause discomfort even after menopause, particularly if:

• A woman has residual endometrial implants that remain hormonally responsive
• She undergoes hormone replacement therapy (HRT), which can reintroduce estrogen into the body
• Estrogen is still produced in small amounts by fat tissue or the adrenal glands
• The variant of endometriosis present produces its own estrogen

Variability in Symptom Relief: Some Women Improve, Others Continue to Have Pain

The impact of menopause on endometriosis varies from person to person. While many women find significant symptom relief after menopause, others may still experience:

• Pelvic or abdominal pain
• Persistent bloating or gastrointestinal discomfort
• Pain during intercourse
• Ongoing fatigue

This variability depends on several factors, including the severity of the disease before menopause, the location of endometrial lesions, and whether any hormonal treatments are being used. Women need to monitor their symptoms and consult with a healthcare provider if pain continues or worsens after menopause.

Postmenopausal Endometriosis

Can Endometriosis Persist After Menopause?

Yes, endometriosis can persist after menopause, although it is less common. While the prevalence of endometriosis in pre-menopausal women is 6-10%, it is estimated at 2-4% in postmenopausal women. While the majority of women experience symptom relief due to the natural decline in estrogen, some continue to deal with endometriosis-related pain or complications even after their reproductive years have ended. In rare cases, endometriosis may even be diagnosed for the first time after menopause. This can be confusing and frustrating for patients who believed the condition was limited to their premenopausal years.

Causes of Postmenopausal Endometriosis

Several factors can contribute to the persistence or reactivation of endometriosis after menopause:

• Hormone Replacement Therapy (HRT):

HRT is often prescribed to manage menopausal symptoms such as hot flashes, night sweats, and vaginal dryness. However, because estrogen stimulates endometrial tissue, HRT can sometimes reactivate dormant endometriosis lesions or worsen existing ones. Women with a history of endometriosis should discuss the risks and benefits of HRT carefully with their healthcare provider. This being said, MOST women with a history of endometriosis can go on HRT without symptoms coming back.  While there are not many studies, those published indicate that less than 10% of patients will have recurrence of symptoms while on HRT.

• Residual or Undiagnosed Lesions:

Endometriotic implants that were not removed or diagnosed before menopause can remain in the body. While these lesions are generally inactive without estrogen, they can still cause symptoms if they become irritated, inflamed, or are affected by low levels of circulating estrogen, still produced by fat tissue or other sources.

Risk of Rare Complications (e.g., Endometriosis-Related Cancer)

Although extremely rare, one of the potential complications of postmenopausal endometriosis is malignant transformation. In a small number of cases, endometriosis can develop into a type of cancer, most commonly endometrioid or clear cell ovarian cancer. The overall risk of ovarian cancer in patients with known endometriosis is 2.5%, while the lifetime risk in the general population is 1.3%. The overall risk is low, but it’s something that healthcare providers monitor closely, particularly in women who present with new or worsening symptoms after menopause.

Signs that may warrant further evaluation include:

• Unexplained pelvic pain
• Abdominal bloating or changes in bowel habits
• Postmenopausal vaginal bleeding
• Unusual growths found on imaging

Because the symptoms can mimic other conditions, early evaluation and ongoing monitoring are important for maintaining long-term health.

Hormone Replacement Therapy (HRT) and Endometriosis

Why HRT Is Sometimes Used During Menopause

Hormone Replacement Therapy (HRT) is commonly prescribed to help manage the often disruptive symptoms of menopause. As estrogen levels drop, many women experience hot flashes, night sweats, mood swings, vaginal dryness, and sleep disturbances. HRT works by supplementing the body with estrogen, sometimes in combination with progesterone, to ease these symptoms and improve quality of life. For many women, especially those in early or surgical menopause, HRT can be a highly effective solution to restore hormonal balance and alleviate discomfort.

Risks of HRT for Those With a History of Endometriosis

While HRT can offer relief, it carries specific risks for individuals with a history of endometriosis. Because endometriosis is fueled by estrogen, reintroducing this hormone into the body may reactivate dormant endometrial lesions, potentially leading to pain, inflammation, or the regrowth of tissue. In some cases, HRT may even lead to the recurrence of endometriosis symptoms years after menopause. The risks are especially elevated if estrogen-only HRT is used without progesterone, as unopposed estrogen can further stimulate tissue growth.

Key concerns for those with a history of endometriosis include:

• Recurrence of pelvic pain or other endometriosis symptoms
• Increased risk of endometriosis-related complications
• Rare risk of malignant transformation of endometriotic lesions

Again, most women with a history of endometriosis can go on HRT without symptoms coming back. Published studies indicate that less than 1 in 10 patients will have recurrence of symptoms while on hormone replacement therapy.

Women with endometriosis considering HRT should work closely with a knowledgeable healthcare provider to evaluate the safest approach. In some cases, a combination of estrogen and progestin may be prescribed to help minimize risks.

Non-Hormonal Alternatives for Managing Menopausal Symptoms

For women with endometriosis, or those who prefer to avoid hormones altogether, there are several non-hormonal strategies to manage menopausal symptoms:

• Lifestyle changes:
  • Regular exercise to reduce hot flashes and improve mood
  • A healthy diet rich in calcium and vitamin D for bone health
  • Stress reduction techniques like yoga or meditation
• Non-hormonal medications:
  • Antidepressants (SSRIs or SNRIs) for hot flashes and mood regulation
  • Gabapentin or clonidine to reduce vasomotor symptoms
• Natural remedies and supplements:
  • Vaginal moisturizers and lubricants for dryness
• Cognitive behavioral therapy (CBT):
  • Effective for managing mood changes and sleep disruptions

Discussing all available options with a healthcare provider can help women with a history of endometriosis find a safe, effective way to navigate menopause while minimizing the risk of symptom recurrence.

Diagnosis and Treatment Options Post-Menopause

How Endometriosis Is Diagnosed After Menopause

Diagnosing endometriosis after menopause can be more challenging than during reproductive years, primarily because the condition is less common and its symptoms may overlap with other gynecological or gastrointestinal disorders. However, persistent pelvic pain, unexplained bleeding, or the appearance of pelvic masses may prompt a closer investigation. In such cases, experienced Gynecologists Charlottesville women trust, like those at The Center for Advanced Gynecology—can provide the specialized evaluation needed to reach an accurate diagnosis and recommend appropriate treatment.

Common diagnostic tools include:

• Imaging Tests:
  • Ultrasound is often the first step, especially to detect ovarian cysts or masses.
  • MRI (Magnetic Resonance Imaging) can provide more detailed images of potential endometriosis lesions or scar tissue that may not appear on an ultrasound.
• Laparoscopy:

This is a minimally invasive surgical procedure in which a small camera is inserted through the abdomen to view internal organs directly. Laparoscopy remains the most definitive method to confirm endometriosis and allows for biopsy or removal of suspicious tissue.

• Pelvic Exams and Medical History:

A thorough physical examination and review of symptoms and history of endometriosis or pelvic surgeries also help guide diagnosis.

• There are no FDA approved non-invasive blood, tissue or other tests for detecting endometriosis yet. (Aug 2025).

Treatment Options

Once diagnosed, treatment for postmenopausal endometriosis focuses on symptom relief and preventing complications. Because estrogen levels are lower, the approach often differs from treatments used during reproductive years.

• Pain Management:

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help manage mild to moderate pain. In cases of chronic discomfort, physicians may recommend:

1. Low-dose antidepressants for chronic pain modulation
2. Physical therapy focused on pelvic floor relaxation
3. Nerve blocks or other pain management procedures if conservative treatments fail

• Surgical Intervention:

For women with severe or persistent symptoms, surgery may be recommended to remove endometriotic lesions or scar tissue. Surgical options can include:

1. Laparoscopic excision of lesions
2. Hysterectomy (removal of the uterus) in more advanced cases
3. Oophorectomy (removal of the ovaries), especially if lesions are hormonally active

• Surgery is often followed by close monitoring to ensure symptoms do not return, especially in women not using hormone replacement therapy.
• Lifestyle and Dietary Strategies:

Holistic approaches can be especially helpful in managing low-grade inflammation and improving quality of life. These may include:

1. An anti-inflammatory diet rich in fruits, vegetables, omega-3 fatty acids, and whole grains
2. Regular physical activity to support pelvic and overall health
3. Stress management techniques such as mindfulness, meditation, or counseling
4. Limiting alcohol and caffeine, which may aggravate symptoms in some women

Treatment should always be tailored to the individual’s symptoms, health history, and personal preferences. A collaborative care approach involving gynecologists, pain specialists, and dietitians can be especially beneficial in managing postmenopausal endometriosis effectively.

Managing Symptoms and Improving Quality of Life

Living with endometriosis after menopause can be frustrating, especially for those who expected their symptoms to subside with the end of menstruation. While some individuals do experience lasting relief, others may continue to struggle with pelvic pain, bloating, fatigue, or emotional distress. Fortunately, there are effective strategies to help manage ongoing symptoms and improve overall well-being.

Tips for Managing Ongoing Pelvic Pain and Other Symptoms

Managing chronic pelvic pain and related symptoms requires a multifaceted approach. Here are some practical tips that can make a significant difference:

• Use over-the-counter pain relievers such as ibuprofen or naproxen to reduce inflammation and discomfort.
• Apply heat therapy (e.g., heating pads or warm baths) to the lower abdomen or back to ease muscle tension and cramps.
• Engage in gentle exercise, including walking, stretching, or yoga, which can help reduce pain and improve mood.
• Adopt an anti-inflammatory diet, focusing on foods rich in fiber, omega-3 fatty acids, and antioxidants.
• Stay hydrated and manage digestion, as bowel-related discomfort can sometimes mimic or worsen pelvic symptoms.
• Practice stress reduction techniques such as meditation, deep breathing, or cognitive behavioral therapy (CBT) to help manage both physical and emotional symptoms.

Importance of Individualized Care

No two cases of endometriosis are exactly alike, especially after menopause. Some women may need only minor adjustments to their lifestyle, while others require medical treatment or surgery to find relief. That's why individualized care is essential. A personalized plan that considers your health history, current symptoms, hormone levels, and treatment goals can lead to more effective and sustainable results. Open communication with healthcare providers ensures that symptoms are not dismissed and that evolving needs are addressed promptly.

Working with a Specialist in Gynecology or Pelvic Pain

For women with persistent or complex symptoms, working with a specialist is key. Gynecologists Charlottesville patients rely on, especially those with expertise in endometriosis or pelvic pain, can offer advanced diagnostic tools and up-to-date treatment options. These providers can:

• Conduct thorough evaluations to rule out other causes of pain.
• Tailor medical or surgical treatments to your specific needs.
• Coordinate care with other professionals, such as physical therapists, pain management doctors, or nutritionists.

Specialist care not only improves symptom control but also empowers individuals with information and support, helping them regain confidence in managing their health and quality of life after menopause.

When to See a Doctor

While some level of bodily change is expected during and after menopause, certain symptoms should not be ignored, especially if you have a history of endometriosis or begin experiencing new issues later in life. Recognizing when to seek medical attention is crucial for early intervention and preventing complications. If you're experiencing concerning symptoms, consulting experienced gynecologists Charlottesville patients rely on, like those at The Center for Advanced Gynecology—can help ensure you receive timely and appropriate care.

Signs That Require Medical Evaluation Post-Menopause

If you experience any of the following symptoms after menopause, it’s important to consult a healthcare provider promptly:

• Persistent or worsening pelvic pain
• New or unexplained abdominal bloating
• Pain during intercourse
• Changes in bowel or bladder habits that don't resolve
• Unexplained fatigue or weight loss
• Postmenopausal vaginal bleeding, even light spotting

These signs could indicate ongoing or recurrent endometriosis, but they may also point to other conditions, including fibroids, gastrointestinal disorders, or, in rare cases, malignancy. Timely evaluation helps ensure that the underlying cause is properly diagnosed and treated.

Importance of Not Dismissing Pelvic Pain or Unusual Bleeding

It’s a common misconception that pelvic pain or vaginal bleeding after menopause is “normal” or something to simply tolerate. In reality, these symptoms always warrant investigation. Pain should not be accepted as an inevitable part of aging, and any form of postmenopausal bleeding should be assessed for possible causes, including endometrial hyperplasia or cancer.

Ignoring or delaying care can lead to missed diagnoses or the progression of a treatable condition. Whether your symptoms are new or persistent from earlier stages of life, seeking medical guidance is a proactive step toward protecting your health and quality of life. If needed, ask to be referred to a gynecologist or pelvic pain specialist with experience in managing endometriosis in postmenopausal women.

Get Support for Endometriosis and Menopause at The Center for Advanced Gynecology

Navigating menopause is challenging enough—and when you add a history of endometriosis, it can be even more complex. At The Center for Advanced Gynecology, we understand how these two conditions can interact and affect your quality of life. Whether you're managing lingering endometriosis symptoms or facing new changes brought on by menopause, our team offers compassionate, personalized care to help you feel your best. Schedule a consultation today and take the next step toward relief and clarity.

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