The symptoms of endometriosis usually subside after menopause, although this isn’t always the case. This condition continues to affect up to 10 percent of women after menopause, with half of them experiencing pain. This is an important consideration, as the causes and treatment options for endometriosis are different after menopause.

Current research is unclear as to whether women can actually develop endometriosis after menopause. However, women who were asymptomatic prior to menopause may begin experiencing pain and other symptoms of existing endometriosis after menopause.

Pelvic pain is the most common symptom of postmenopausal endometriosis, just as it is for women who are still menstruating. However, heavy bleeding is more common after menopause. This symptom is of greater concern due to the possibility of postmenopausal endometriosis progressing into ovarian cancer, which occurs in about one percent of cases.

Endometrial tissue can cause pain when it grows outside the uterus, which also mirrors the symptoms of other postmenopausal health conditions such as ovarian cancer. This condition can persist after menopause, even though the menstrual cycle and other ovarian functions that caused it are no longer occurring. The exact mechanism for this process is unclear, although elevated estrogen levels are a known risk factor for endometriosis, regardless of age.

Current research suggests that estrogen sources such as plant-based estrogens, known scientifically as phytoestrogens, and hormone replacement therapy (HRT) can contribute to the progression of endometriosis after menopause. These therapies are often used to relieve the symptoms of menopause. Tamoxifen is another possible cause of postmenopausal endometriosis, which is used to treat breast cancer. However, this drug also stimulates the production of estrogen in endometrial tissue, increasing the risk of lesions. Additional factors that may play a role in postmenopausal endometriosis include genetics, stress, hypothyroidism, and a high level of fatty acids in the diet, especially unsaturated omega 3.

A hysterectomy is a surgical procedure in which the uterus is removed. It may also include the removal of the fallopian tubes and uterus, in which case it’s known more specifically as a salpingo-oophorectomy. Nevertheless, endometriosis can still recur after hysterectomy, typically when the surgery fails to remove lesions on tissue that isn’t removed. In particular, hysterectomies that don’t include the removal of ovaries have a greater risk of relapse.

HRT presents a dilemma for healthcare practitioners with postmenopausal patients. This therapy typically consists of a combination of estrogen and progesterone, since the body’s natural production of these hormones decreases after menopause. These hormones relieve the symptoms of menopause, but they also increase the risk of endometriosis. This risk is particularly high when endometrial lesions remain after surgery, which often occurs when the disease is in an advanced state that makes the removal of all lesions impractical.

HRT thus presents a dilemma for healthcare practitioners with postmenopausal patients. The general solution is to find a dosage high enough to relieve postmenopausal symptoms, without being high enough to cause the formation of endometrial lesions. These dosage levels often overlap, making it impossible to meet both objectives.

For more information, please visit our complete Endometriosis Guide.