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What could menopause mean if you have endometriosis? Find out more about endometriosis and menopause, plus how you can prepare and find advice.
Pelvic pain, heavy bleeding, and questions around fertility – you might already have experienced these for years if you have endometriosis.
So, how do you know if your symptoms are menopause? And will the traditional options work for you?
Endometriosis and early menopause
You could be more likely to start perimenopause earlier if you have endometriosis.1 So, don’t doubt any suspicions, even if you think you’re too young.
Research which analysed the data of over 100,000 women from the Nurses’ Health Study II between 1989 and 2015 found that early menopause is even more likely among women with endometriosis who took oral contraceptives or who had never given birth.1
Endometriosis and perimenopause
Since endo and menopause symptoms can be similar, it might be tricky to tell what’s what. Maybe you’ve been told to look out for irregular periods or pain during sex – but that’s not helpful if you experience them already.
Instead, you might notice a flare-up in your usual symptoms. Oestrogen levels fluctuate dramatically in perimenopause and these hormonal changes may interfere with endometriosis in a similar way to your periods.2
Does endometriosis stop after menopause?
Endometriosis after menopause is rare, since your body has significantly lower levels of oestrogen than before.3 That’s why doctors sometimes induce early menopause in severe cases of endometriosis.4
However, around 2-4% of postmenopausal women with endometriosis continue to have symptoms.5
Although your endometriosis symptoms might decrease, you might experience new symptoms specific to menopause, like: 6
- mood swings
- hot flushes and night sweats
- vaginal atrophy
Managing menopause with endometriosis Medication
In the UK, about 15% of menopausal women take hormone replacement therapy (HRT) to help manage their symptoms.7
However, HRT increases your oestrogen levels, meaning it could make endometriosis come back.8 There’s also the risk of ‘malignant transformation’, which is when endometriotic lesions become cancerous. This is rare, but worth considering.
HRT is a suitable option for some menopausal people with endometriosis. Your doctor can help you decide whether it's suitable depending on your preferences, individual risks, and medical history.
If you reach menopause naturally, you may have to stop any birth control medications prescribed for your endometriosis, but always check with your doctor.5
Your physical health
1. Exercise
It’s important to continue exercising as it helps reduce the potential damage to your bones and heart.9,10,11
However, endometriosis can make exercise painful. Don’t try to push past it or purposely do painful exercises.
Your limits can change from day to day, so it's important to choose activities that feel safe and comfortable depending on how you’re doing.
2. Weight management
About 50% of women will gain weight around menopause, as oestrogen levels and muscle mass reduce.12 Maintaining a healthy weight helps reduce the cardiovascular and bone health risks that can increase.9,10,11
According to the British Menopause Society, you should aim for ¼ protein, ¼ carbohydrates, and ½ fruit and veg on your plate in each meal.12
If you’re having trouble losing weight, your doctor can recommend a safe, personalised calorie deficit.
3. Physiotherapy
Physiotherapy may help you manage endometriosis symptoms by helping with connective tissue issues in the pelvic floor.13
Research specifically into physiotherapy for endometriosis and menopause is limited, but your doctor may refer you to a specialist for pelvic pain or urinary urgency.
Endometriosis UK has a pelvic exercise programme you can do at home to help rebalance some of the muscles that can be affected.
Your mental health
1. Exercise
While you shouldn’t do exercise that’s painful, staying active and outdoors can help you stay mentally well if you’re struggling.
Aside from helping you stay fit, regular exercise and outdoor activity can help to reduce feelings of anxiety and depression and help improve your mood.14
2. Cognitive behavioural therapy (CBT)
Some people find that CBT is useful for managing their mood.
Hormonal changes during menopause can increase certain feelings and bring new ones altogether. In a 2019 survey, 53% of menopausal women reported low mood and depression and 50% reported anxiety.15
CBT focuses on helping people cope better with their symptoms in daily life, whether these symptoms are physical or emotional. It encourages patients to find patterns in their thoughts, feelings, and behaviours, and break these down into smaller parts.
The therapist helps the patient find ways to reduce unhelpful areas and instead learn management strategies to implement during and after therapy.16
3. Getting the information you need
If you have endometriosis, you may experience menopause at a younger age.1 So you might be less prepared when it comes or have fewer people around you to talk to.
It’s important that your GP informs you about what endometriosis means for your menopause. It’s a good idea to start a conversation with them now, to discuss your options for now and the future.
You may want to talk about:
- how you’re currently managing symptoms
- how your symptoms might change
- whether you want to conceive – and, if so, when
- potential treatment options once you begin menopause
Organisations like Endometriosis UK, The British Menopause Society, Mind, and The Menopause Charity also have resources that you may find useful.
Finally, you can book a 1-to-1 consultation with our trained menopause advisors, who’ll provide confidential advice on your individual menopause.
The final say
Everyone’s experiences of endometriosis and menopause are different, so it can be tricky to know what to expect. But you shouldn’t have to feel left out.
No matter your age, your GP can talk you through your individual options. Our H&B trained menopause advisors are also available to help you feel more confident about your next steps
The advice in this article is for information only and should not replace medical care. Please check with your GP or healthcare professional before trying any supplements, treatments or remedies. Food supplements must not be used as a substitute for a varied and balanced diet and a healthy lifestyle.
1. Thombre Kulkarni M, Shafrir A, Farland LV et al. Association Between Laparoscopically Confirmed Endometriosis and Risk of Early Natural Menopause. JAMA Network [Internet]. 2022 Jan 21 [cited 2024 Mar 7]. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788287
2. Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt) [Internet]. 2015 Apr 1 [cited 2024 Mar 7]; 25(4): 332-339. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834516/
3. De Almeida Asencio F, Abdalla Ribeiro H, Ayrosa Ribeiro P, Malzoni M, Adamyan L, Ussia A, Gomel V, Martin DC, Koninckx PR. Symptomatic endometriosis developing several years after menopause in the absence of increased circulating estrogen concentrations: a systematic review and seven case reports. Gynecological Surgery [Internet]. 2019 Feb 15 [cited 2024 Mar 7]. Available from: https://gynecolsurg.springeropen.com/articles/10.1186/s10397-019-1056-x#Tab1
4. Gemmell LC, Webster KE, Kirtley S, Vincent K, Zondervan KT, Becker CM. The management of menopause in women with a history of endometriosis: a systematic review. Hum Reprod Update [Internet]. 2017 Jul [cited 2024 Mar 7]; 23(4): 481-500. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5850813/
5. Jakson I, Lindén Hirschberg A, Gidlöf SB. Endometriosis and menopause – management strategies based on clinical scenarios. AOGS [Internet]. 2023 Apr 26 [cited 2024 Mar 7]; 102(10): 1323-1328. Available from: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.14583
6. Secosan C, Balulescu L, Brasoveanu S, Balint O, Pirtea P, Dorin G, Pirtea L. Endometriosis in Menopause – Renewed Attention on a Controversial Disease. Diagnostics (Basel) [Internet]. 2020 Mar [cited 2024 Mar 7]; 10(3): 134. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151055/
7. GOV.UK. Hundreds of thousands of women experiencing menopause symptoms to get cheaper HRT [Internet]. Department of Health and Social Care; 2023 Feb 21 [updated 2023 Mar 17; cited 2024 Mar 7]. Available from: https://www.gov.uk/government/news/hundreds-of-thousands-of-women-experiencing-menopause-symptoms-to-get-cheaper-hormone-replacement-therapy
8. NHS. Treatment – Endometriosis [Internet]. NHS; [reviewed 2022 Sep 5; cited 2024 Mar 7]. Available from: https://www.nhs.uk/conditions/endometriosis/treatment/
9. NHS. Things you can do – Menopause [Internet]. NHS; [reviewed 2022 May 17; cited 2024 Mar 7]. Available from: https://www.nhs.uk/conditions/menopause/things-you-can-do/
10. NHS. Physical activity guidelines for older adults [Internet]. NHS; [reviewed 2021 Sep 24; cited 2024 Mar 7]. Available from: https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults/
11. British Heart Foundation. Menopause and your heart [Internet]. British Heart Foundation [cited 2024 Mar 7]. Available from: https://www.bhf.org.uk/informationsupport/support/women-with-a-heart-condition/menopause-and-heart-disease
12. British Menopause Society (BMS). Menopause: Nutrition and Weight Gain [Internet]. BMS c2023 [cited 2024 Mar 7]. Available from: https://thebms.org.uk/wp-content/uploads/2023/06/19-BMS-TfC-Menopause-Nutrition-and-Weight-Gain-JUNE2023-A.pdf
13. Oliver A, Overton C. What the physiotherapist needs to know about endometriosis. Journal of the Association of Chartered Physiotherapists in Women’s Health [Internet]. 2014 [cited 2024 Mar 7]; 114: 44-49. Available from: https://thepogp.co.uk/_userfiles/pages/files/oliver.pdf
14. Mind. How are physical health and mental health connected? [Internet]. Mind [2023 Oct; cited 2024 Mar 7]. Available from: https://www.mind.org.uk/information-support/tips-for-everyday-living/physical-activity-exercise-and-mental-health/how-are-physical-activity-and-mental-health-connected/
15. Health and Her. A fact-based focus on Perimenopause and Menopause issues faced by women [Internet]. Health and Her; [2021 Sep; cited 2024 Mar 7]. Available from:https://committees.parliament.uk/writtenevidence/39340/pdf/
16. NHS. Overview – Cognitive behavioural therapy (CBT) [Internet]. NHS [reviewed 2022 Mar 14; cited 2024 Mar 7]. Available from: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/talking-therapies-and-counselling/cognitive-behavioural-therapy-cbt/overview/
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