Menopause and Endometriosis: Menopause & Chronic Conditions Series

Menopause and endometriosis are two distinct yet interconnected phases in a woman's life that can bring about significant physical and emotional changes. Menopause marks the end of the reproductive years, while endometriosis is a chronic condition characterised by the growth of tissue similar to the lining of the uterus outside the uterus. Understanding how these two conditions intersect is crucial for women facing both challenges.

What is Endometriosis?

Endometriosis is a condition where the lining of the womb, the endometrium, grows outside of the womb on other organs including ovaries, fallopian tubes, outside of the womb, bladder and bowel. The cause of it is largely unknown but it is believed to be related to several different things, including retrograde menstruation, (where menstrual blood flows backwards into the fallopian tubes instead of externally via the cervix); genetics; previous abdominal surgical scarring; immunity problems and hormonal imbalances.

Symptoms can include severe abdominal pain; and extremely heavy, painful periods. It is a debilitating condition which can affect women (assigned female at birth) of any age and lead to long-term problems with fertility.

It is estimated it takes an average of eight years from the onset of symptoms to diagnosis. There is no known cure for the condition and management can involve pain relief, hormonal contraception, surgery to remove additional endometrial tissue or affected organs, or hysterectomy.

What happens to endometriosis during perimenopause?

Although the exact cause of endometriosis is unknown it is believed to be exacerbated by Oestrogen. Therefore, when Oestrogen drops in the menopause, generally, endometriosis symptoms can improve. Although one study reported a small number of women, 2-5%, developed endometriosis post-menopause.

Endometriosis and HRT

Despite the improvements with endometriosis symptoms menopause symptoms can still be difficult to cope with. There is very little research in the effects of HRT on Endometriosis, but it is believed the Oestrogen component in HRT can exacerbate the growth of abnormal endometrium which greatly increases the risk of Endometrial Cancer.

In individuals with endometriosis who have retained their womb, it is advised to add Progesterone to the HRT prescription. This helps to reduce endometrial growth and lower the risk of endometrial cancer. Individuals who have had a hysterectomy for the treatment of endometriosis may still require additional progesterone unless the surgeon is sure all abnormal endometrial tissue has been removed.

Individuals should watch for returning symptoms as there is a small risk of the condition regenerating post-menopause and report symptoms as soon as possible to their GP or Gynaecologist.

Emotional wellbeing

Both menopause and endometriosis can have profound effects on emotional well-being. The physical changes, coupled with the psychological impact of fertility loss, may necessitate emotional support through counselling or support groups.

Regular Monitoring

Endometriosis is debilitating and difficult to manage. It requires multiple tests to achieve an eventual diagnosis and can result in infertility. Some relief may be achieved post-menopause as Oestrogen levels drop but this, in turn, leads to a different set of symptoms which can be equally debilitating and difficult to manage. Therefore, careful management and close observation can help to provide the individual with a smooth transition to later life.

myTamarin Support

If you would like to discuss this or any other menopause issues further, book a 1-1 appointment with one of our menopause specialists at myTamarin either via your company landing page, or in the app.

References

NHS, (2022) Endometriosis. www.nhs.uk
Anon, (2023) Endometriosis: Symptoms, Causes, Diagnosis and Treatments. Www.msn.com
Endometriosis UK, (2023) www.endometriosis-uk.org
Fletcher, J. (2023) Endometriosis and Menopause: What Happens and More. www.medicalnewstoday.com
Newson Health, (2023) Endometriosis and HRT. www.balance-menopause.com