Endometriosis After Menopause

Endometriosis tissue responds to hormones just as the endometrium (lining of the uterus) does. Estrogen stimulates its growth, while progestin inhibits its growth. Endometriosis symptoms often diminish after menopause, when estrogen levels drop. People who have been through menopause can still experience endometriosis, although less frequently than people who are still menstruating.

In some cases, endometriosis seems to develop after menopause in people who did not experience it before menopause. Research is lacking on whether these cases are largely a recurrence of premenopausal endometriosis or de novo (new) cases developing entirely after menopause.

This article will discuss if endometriosis can go away after menopause, whether it can develop after menopause, how postmenopausal endometriosis is diagnosed, how it is treated, and possible complications of postmenopausal endometriosis.

Does Endometriosis Go Away After Menopause?

Endometriosis tissue responds to estrogen. When estrogen levels drop after menopause, endometriosis often goes into remission.

This drop in estrogen causes symptoms of endometriosis to decrease but also promotes symptoms associated with menopause, such as night sweats, hot flashes, mood swings, and vaginal dryness/atrophy.

Endometriosis can reactivate after menopause, particularly if estrogen levels rise again, such as after starting hormone replacement therapy.

The prevalence of endometriosis in reproductive-aged women is 2% to 10%, while in those who have been through menopause, the prevalence is an estimated 2.5%.

Note that when research or health authorities are cited, the terms for sex or gender from the source are used.

Can You Develop Endometriosis After Menopause?

Existing endometriosis can persist past menopause. In some cases, endometriosis can develop even several years after menopause. It is difficult to determine, however, whether postmenopausal cases are new or if they were previously undiagnosed and that asymptomatic endometriosis has progressed to the point of being symptomatic.

It is rare for a person to develop endometriosis several years past the onset of menopause if they are not taking menopausal hormone therapy (MHT).

Some theories as to why endometriosis could develop or recur after menopause include:

• Use of MHT, which causes estrogen levels to rise

• Use of phytoestrogens (plant-based estrogens that mimic estrogen)

• Events or changes that are due to genetics (how genes and heredity affect health) or epigenetics (how your behaviors and environmental factors influence the way genes are expressed)

• Use of tamoxifen (a selective estrogen receptor modulator often used to treat breast cancer)

• Possible estrogen production involvement from adipose tissue (body fat), adrenal glands (endocrine glands on top of the kidneys that produce important hormones), or other factors
  

A person is considered to be in menopause 12 months after their last menstrual period. The approximately seven to 14 years before menopause is called the menopausal transition or perimenopause. This usually happens from age 45 to 55, but this can vary. Some medications and certain surgeries, such as the removal of the ovaries and uterus, can also trigger menopause.

During perimenopause, the production of estrogen and progesterone (hormones made by the ovaries) can vary.

Perimenopause can cause symptoms such as:

• Changes in menstruation

• Hot flashes

• Bladder control changes

• Difficulty sleeping

• Changes to vaginal health and sex

• Mood changes

The period after menopause is called postmenopause. People who are in postmenopause are more vulnerable to heart disease and osteoporosis, a condition in which bone density and mass decrease.

Diagnosing Postmenopausal Endometriosis

The ovaries are the most common area for endometriosis tissue to be found in people who have been through menopause.

Using laparoscopy (a minimally invasive procedure) to perform a biopsy is the gold standard procedure for diagnosing endometriosis at any age.

In a laparoscopy, by making small incisions in the abdomen, the surgeon can inspect the pelvis for endometrial tissue, perform a biopsy by removing a small sample of tissue to be examined in a lab, and sometimes remove endometrial tissue and scar tissue during the same procedure.

Other tests may be used for a less-invasive option, but their accuracy in the diagnosis of endometriosis can vary. These may include:

• Transvaginal sonography (TVS): An instrument shaped like a wand that creates sound waves is inserted into the vagina to get a more detailed look at pelvic organs.

• Magnetic resonance imaging (MRI): A large magnet, radio waves, and a computer are used to produce detailed images of structures inside the body.

• Computerized tomography (CT): This type of imaging uses X-rays and computer technology to produce images of inside the body.

• Rectal endoscopic sonography: A thin, lighted tube with a camera attached is inserted into the rectum and uses sound waves to look for problems in the lower gastrointestinal tract.

• Three-dimensional (3D) ultrasound: This type of imaging converts two-dimensional ultrasound images into more realistic-looking 3D images

What Other Conditions Could Be Causing Symptoms?

The symptoms of endometriosis can be similar to those of other conditions. The risk of conditions such as ovarian cancer, which can mimic endometriosis symptoms, increases with age, so checking for other conditions along with endometriosis is important, particularly in older adults.

Postmenopausal Endometriosis Treatment

Surgical removal of endometrial tissue is considered a first-line treatment for people who have been through menopause.

Several studies have noted significant improvement in symptoms and decreased risk of malignancy (cancer) after complete resection (cutting out) of all visible endometrial tissue in people who have been through menopause.

If surgery is not an option, or if there is a recurrence of endometriosis after surgery, other treatment options include:

• Progestogens: These are a form of the natural hormone progesterone that suppress the growth of and may even shrink endometrial tissue.

• Aromatase inhibitors: These medications stop the enzyme aromatase from changing other hormones into estrogen. They can help with pain relief and may help reduce the size of lesions (areas of endometrial tissue).

Hormone Replacement Therapy and Endometriosis

Because of insufficient data, there is currently no set recommendation on whether people with a history of endometriosis should take MHT (also called hormone replacement therapy, or HRT).

While MHT may play a role in the recurrence or worsening of endometriosis, lowered estrogen levels can trigger symptoms that may interfere with quality of life. Lowered estrogen levels also increase the risk of cardiovascular disease and bone disease. MHT can help counteract these effects.

Decisions about MHT should be made on a case-by-case basis between the patient and their healthcare provider, weighing the benefits and risks of taking MHT and the types available.

For people who have premature or surgically induced menopause, the benefits of MHT may outweigh the risks, and MHT until the average age of natural menopause should be considered.

Complications of Untreated Endometriosis After Menopause

The risk of endometriosis lesions becoming cancerous is higher in people who have been through menopause than those still in their reproductive years. Malignant lesions could spread to the ovaries, the bowels, the lungs, or other areas.

While surgery can help prevent complications from endometriosis, surgery in older adults can have increased risks as well, often because of the increased occurrence of comorbid (co-occurring) conditions.

Talk to your healthcare provider about what you can do to help reduce your risk of postmenopausal endometriosis complications.

Early Menopause as a Side Effect of Endometriosis Treatment

Medications such as GnRH analogues and surgeries such as oophorectomy (removal of ovaries) can help drastically and quickly lower estrogen levels, helping to relieve symptoms of endometriosis. These treatments work by inducing menopause, so the symptoms that come with natural menopause can also occur.

Symptoms of menopause can be more prevalent and more severe in people who experience the sudden drop in estrogen associated with induced menopause than in those who transition into menopause naturally.

MHT may help find a balance between the effects of early menopause and the relief from endometriosis.

Can You Have Endometriosis After a Hysterectomy?

It is possible to continue to have or to develop endometriosis after a partial or total hysterectomy. This is more likely to occur when estrogen therapy is used.

Summary

Endometriosis typically occurs in people of reproductive age who menstruate, but it can persist into or develop after menopause.

The drop in estrogen that occurs in menopause can cause endometriosis to go into remission but also may cause other symptoms associated with menopause, such as mood swings, vaginal dryness, and hot flashes. People who have been through menopause are also at an increased risk of cardiovascular disease and bone diseases such as osteoporosis.

Endometriosis is usually diagnosed with laparoscopic surgery and biopsy. Other imaging tests, such as ultrasound, CT, or MRI, may also be used.

Endometriosis can also be treated with laparoscopic surgery. If surgery is not an option, medications may be helpful. Treatments that induce menopause can help manage endometriosis.