Can You Develop Endometriosis After Menopause
Current research is not clear on if you can get endometriosis after menopause if you did not suffer from the condition during premenopause.
What research does claim is the possibility for premenopausal women to have asymptomatic endometriosis – meaning the disease did not exhibit symptoms – that is now progressing into their postmenopausal years.3
In short, postmenopausal endometriosis can arise in those with premenopausal history of the gynecological condition.
Can Endometriosis Lead To Cancer
There is no evidence that endometriosis causes cancer. The number of women with cancer is similar in a group of women with endometriosis as compared to a group of women without endometriosis. Some cancers, such as ovarian cancer and non-Hodgkin’s lymphoma, are slightly more common in women with endometriosis..
Women who have endometriosis do not need to have their ovaries removed at menopause unless there are other risk factors . If the ovaries of all women who had endometriosis at menopause were removed, with the aim of reducing the risk of ovarian cancer, more deaths would occur due to other diseases such as heart disease or complications related to bone fracture.
There is currently no screening for ovarian cancer. Discuss your risk factors with your doctor.
Can Endometriosis Develop After Menopause
Endometriosis can also develop after menopause but it is rare and could be associated with the use of:1
- Hormone replacement therapy
However, it is unclear whether the growth of lesions is independent to estrogen, or if there is a sensitivity to estrogen, or production of estrogen, comes from the lesion itself.2
It should be noted there is limited data on the effects of hormone therapy and endometriosis. It is believed that even after surgery involving a total hysterectomy, estrogen therapy was found to initiate endometriosis symptoms. Additionally estrogen therapy increases the risk of cancer, whereas other types of hormone therapy may not cause symptoms post-surgery.3
Another theory is that genetic changes or epigenetics are involved the development of endometriosis in menopause, which means there is a modification of the way genes are expressed. A case study of several postmenopausal women identified that all cases of endometriosis lesions were either ovarian cysts or deep infiltrating endometriosis, which is where lesions are found in other places such as the bowel and bladder.2
Its believed that the lesions in cystic and deep infiltrating endometriosis have an ability to grow despite the lower levels of estrogen that occur after menopause, and instead start to proliferate because of genetic or epigenetic events.2
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How Do I Get A Second Opinion Can I Be Referred To Another Consultant
It is important to feel able to communicate with your healthcare professional. They should check your understanding of the condition, explain any medical terms and let you ask questions. If you are not happy or dont feel comfortable with the advice or treatment from your GP or consultant, do ask for a second opinion. Before you get a second opinion it is worth considering whether this is due to a breakdown in communication. If you do not understand an explanation you have been given, you could ask your doctor to explain it to you again. Your GP will be able to give you advice on getting a second opinion from a consultant. If you wish to see a different GP, you can make an appointment with another GP in the practice or try to change practices. NHS direct has a useful guide to getting a second opinion on the NHS.
A Note On Phytoestrogens
It should be noted that the link between phytoestrogen intake from the diet and endometriosis is not fully understood. And when it comes to human studies, the evidence is mixed:
- A population-based study found an increased risk of endometriosis in women who were fed soy-based formulas as infants.4
- In contrast, two other studies have found no evidence that soy intake was associated with endometriosis and may even be linked with a lowered risk.5,6
Soy products contain very high levels of phytoestrogens. You can read more about soy and endometriosis in this article.
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Does Endometriosis Go Away
In a single word, no.
Endometriosis doesn’t go awayand if it is ignored it will typically continue to grow.
Unfortunately, too many doctors and parents claim that period pain is “normal.” Heavy or irregular bleeding is often ignored.
But endometriosis can cause serious problems, including:
- chronic pain
- irreversible damage to the organs inside the pelvis
Endometriosis, large cysts, lesions and adhesions covering the inner surfaces of my abdomen.
What Can I Do To Help With Lack Of Sex Drive
Lack of libido or sex drive can be due to many factors but in women with endometriosis it can relate to pain during intercourse or an induced menopause causing lack of the male hormone testosterone which plays an important role in the sex drive. Vaginal estrogen treatment can help vaginal dryness and pain and can be used along with lubricants during sex. An HRT called Tibolone can also be helpful as it has some androgen in it along with estrogen and progesterone and may help with women with a reduced sex drive. In some cases, your doctor may suggest using a small amount of testosterone gel alongside your continuous combined HRT to increase libido. This may take several months to take effect.
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Which Is The Right Treatment For Me
The right treatment is the one that works for you and helps you. Everyone is different and will respond differently to each treatment. Peoples view on surgery and side effects of medication vary, and these will need to be taken into account as well. You may have to try several types of treatment to find one that you are comfortable with. Alternatively, you may decide to not treat the endometriosis.
How Can I Find Out About Self
Self-management courses enable people living with long term conditions to manage their symptoms. They run over a 6 week period for people with chronic conditions. These courses have a proven track record of benefiting those living with a long term illness and should not be under-estimated. The courses are free of charge. Your GP or local Primary Care Trust will be able to provide information on courses. For more information about self-management and courses go to www.expertpatients.nhs.uk.
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Endometriosis After A Hysterectomy Or Menopause
- CategoriesNook News
- Date May 6, 2021
Endometriosis does not die off or go away with a hysterectomy or menopause. Some people do find some relief from their symptoms, but endometriosis can still persist. Endometriosis often has several related or comorbid conditions that share similar symptoms that a hysterectomy might help but it may not stop your symptoms from endometriosis. Endometriosis exists outside of the uterus and can still respond to hormonal influences . Even if your ovaries are removed, endometriosis lesions can produce their own estrogen . This is important to note because estrogen causes endometriosis lesions to grow and persist . So even with the removal of the ovaries or with menopause, endometriosis can sustain itself.
There is high recurrence of symptoms with the removal of just the uterus but, even with the removal of the ovaries, any endometriosis lesions left behind can continue to grow, progress, and cause symptoms . So, if you have your uterus and ovaries removed for other conditions, it is best that all endometriosis lesions be removed as well. The skill of the surgeon at removing all endometriosis is important. Rizk et al. report that the recurrence of endometriosis symptoms and pelvic pain are directly correlated to the surgical precision and removal of peritoneal and deeply infiltrated disease.
What Menopausal Treatments Are Most Appropriate For Women With Previous Endometriosis
If a woman with a history of endometriosis does decide to opt for HRT, then the next decision must be to choose the most suitable preparation. Again, there is limited high-quality evidence on which to base this decision. Two studies, retrieved by our search, provide some insight into this question. The first was a RCT comparing HRT using transdermal oestradiol with tibolone, and the second was an observational study comparing oestrogen-only HRT with combined HRT. Both were assessed as very low quality using the GRADE system.
The RCT compared HRT and tibolone in women with residual endometriosis after bilateral oophorectomy. Patients were randomized into one of the two treatment groups and followed for 1 year. Four patients in the oestradiol group experienced moderate pelvic pain during treatment compared to only one patient in the tibolone group. Furthermore, one patient in the HRT group discontinued treatment at 8 months due to the development of dyspareunia and post-coital bleeding from a vaginal mucosal endometriotic deposit. The authors concluded that tibolone may be a safer alternative for postmenopausal women with residual endometriosis, although note that their trial was very small.
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When To See A Doctor
If youre not recovering well from your hysterectomy, see your doctor. Whether youve ever received a diagnosis of endometriosis or not, bowel problems shouldnt be ignored.
Thats why its so important to mention all your symptoms to your doctor in detail.
Your complete medical history, physical examination, and blood tests can help guide the next steps.
Your doctor may order diagnostic imaging tests, such as:
Observational Studies And Clinical Trials
Only six observational studies and clinical trials were identified by our search, highlighting the paucity of higher-level evidence in this area. These studies aimed to cover a variety of clinical questions, and the evidence for these is summarized below and in Table . All assessed recurrence of endometriosis as their primary outcome.
Should Hrt Be Given To Women With Previous Endometriosis
Given the concerns of possible disease reactivation or malignant transformation of endometriotic foci, it is reasonable to consider whether treatment with HRT is justifiable in this group of women. However, in a field dominated by case reports and series, it is challenging to obtain information on risk. Our search identified a single RCT and two cohort studies that give some insight regarding the risk of HRT in this cohort of women. All three studies were assessed as very low quality by GRADE criteria .
One observational study included women who took postoperative HRT and those who did not . In this retrospective, single centre cohort, the authors identified 107 women who had undergone hysterectomy and BSO for treatment of endometriosis. Women were treated with a variety of HRT regimens or no treatment . Recurrence was only identified in four women and all were receiving HRT, specifically unopposed oestrogen therapy. Three women had recurrent pain, and one woman had a vaginal nodule, confirmed as endometriosis on histology.
What Does Menopause Mean For Endometriosis
According to Gennev ob/gyn and Director of Health Dr. Rebecca Dunsmoor-Su, endometriosis is estrogen-dependent, so when estrogen is gone, so is the disease. However, this does not mean every woman suddenly finds herself pain-free at menopause. Chronic pelvic pain may continue, and well tackle that very important condition in a future blog.
Whether symptoms abate or not, after menopause, conversations about endometriosis may need to include some additional concerns:
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Severe Consequences For Ignoring Endometriosis
A new surgeon and another operation discovered extensive diffuse adenomyosisthe rogue endometrial cells had buried themselves deep into the uterus muscle wall.
Such adenomyosis is only treatable with a hysterectomy, but I was only 26, far too young.
In addition to severe pain, adenomyosis causes infertility, high rates of miscarriage and birth defects due to the damaged muscle and an impaired blood supply.Had doctors discovered and removed the endometriosis before it got so extreme, the adenomyosis would not have developed.
I had to cope with chronic, severe pain and undergo two more endometriosis-removal operations before I was allowed to have a hysterectomy at age 38. They still wouldn’t take my ovaries out, because I am too young.
I am now unable to have children, because my period pain was ignored by doctors.
The Management Of De Novo Endometriosis In Postmenopausal Patients And Pain Management
De novo endometriosis appears especially after unopposed estrogen therapy or obesity, which has an additional effect for increasing the risk of endometriosis development.
Postmenopausal women with symptomatic endometriosis should be managed surgically with removal of all visible endometriotic tissue because of the higher risk of recurrence and the risk of malignancy . A similar approach is recommended by current ESHRE recommendations. Medical therapy can be used in case of pain recurrence after surgery or if surgery is contraindicated. Co-morbidities represent an additional risk to contraindicate surgery and include advanced age or pelvic adhesions from previous surgery . Approximately 12% of all endometriosis cases will finally require a hysterectomy with or without oophorectomy . To prevent recurrences, to restore bowel, urinary, or sexual function or to alleviate pain it is now recommended to remove all the implants .
Progesterone administration has been proposed as a reliable alternative treatment in patients with contraindication for surgery, but, up to date, no extensive data is available and further studies are needed regarding progesterone use in postmenopausal endometriosis .
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If You Have Endometriosis
What’s your experience with endometriosis?
Did your doctor’s ignore your pain too?
This content is accurate and true to the best of the authors knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
What Causes Bowel Endometriosis After Hysterectomy
Its not clear how the condition progresses. Its not clear why endometrial tissue grows on the bowels, either. But after the genital organs, its the most common place for it to occur.
At the time of your hysterectomy, its possible that there were small lesions in the bowels that hadnt been detected.
Here are some potential causes of bowel endometriosis.
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Symptoms Of Endometriosis Recurrence
Accurate diagnosis of recurrence is difficult and only confirmed by second look laparoscopy, which poses particular risk to patients with prior surgery. Diagnosis of recurrence on the basis of symptoms or diagnostic imaging can be challenging. Pelvic pain and dyspareunia are the most common presenting symptoms of recurrent endometriosis after hysterectomy, although vaginal and rectal bleeding as well as low back and rectal pain may also occur . Painful defecation and severe dyspareunia may indicate deeply infiltrating lesions . For these patients, it can be difficult to identify the exact cause of pain, because the differential diagnosis is broad, including ovarian remnant syndrome, post-surgical adhesions, and recurrent endometriosis .
Can Endometriosis After Hysterectomy Recur
Yes, the endometriosis after hysterectomy can recur, and the hysterectomy cannot guarantee a cure for endometriosis.
As one of the common treatment options for endometriosis, surgical removal of the uterus is reported that pain and other symptoms of endometriosis may recur, where a second operation is needed to remove endometrial implants that develop in other parts of the pelvis.
Another surgical method includes the removal of the ovaries during a hysterectomy for women with endometriosis. Some studies show that this treatment method has better results than just a hysterectomy, and fewer women needing a second surgery to treat endometrial implants. The problem, however, with this method is that it may cause premature menopause in young women. That may be because that the ovaries produce hormones that are responsible for maintaining secondary female features and hormonal balance. To avoid premature menopause, hormone replacement therapy would be necessary.
Symptoms of Recurring Endometriosis After Hysterectomy
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What Other Health Conditions Are Linked To Endometriosis
Research shows a link between endometriosis and other health problems in women and their families. Some of these include:
- Allergies, asthma, and chemical sensitivities
- Autoimmune diseases, in which the body’s system that fights illness attacks itself instead. These can include , , and some types of .
- Certain cancers, such as and breast cancer
Ovarian And Uterine Cancers
Other symptoms of these cancers can include:
- vaginal bleeding
Conditions that cause cramps after menopause may be more likely to occur in people who:
- started their periods before the age of 12
- began menopause after the age of 52
- take estrogen to help control the symptoms of menopause
- have a family history of ovarian or uterine cancers
If abdominal or pelvic cramps are accompanied by other concerning symptoms, especially vaginal bleeding, a person should see a doctor, as soon as possible.
Anyone who is concerned about abdominal or pelvic cramping should also see a doctor.
A doctor will ask a person about their symptoms and medical history and do a physical examination. They may recommend referral to a specialist for further testing.
To discover if an underlying condition is causing abdominal cramps, a doctor may perform one or more of the following tests:
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How Common Is Recurrence Of Endometriosis After Having A Hysterectomy/menopause
This is not common. It is more likely after hysterectomy if the ovaries have been left behind with or without disease. This can happen sometimes because endometriosis surgery can be very difficult. Endometriosis after the menopause is thankfully rare as a result of markedly reduced ovarian oestrogen production but can occur when HRT is used.