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.
The Combined Oral Contraceptive Pill
The combined contraceptive pill contains the hormones oestrogen and progestogen.
They can help relieve milder symptoms, and can be used over long periods of time.
They stop eggs being released and make periods lighter and less painful.
These contraceptives can have side effects, but you can try different brands until you find one that suits you.
Your doctor may recommend taking 3 packs of the pill in a row without a break to minimise the bleeding and improve any symptoms related to the bleeding.
Ovarian And Uterine Cancers
Cancer of the ovary or uterus can cause abdominal cramps. Your risk for these cancers increases in your 50s and beyond. Cramps alone arent reason to assume you have cancer. Women who have cancer usually have other symptoms along with cramps, such as:
- vaginal bleeding
- unexplained weight loss
Any worrisome symptoms warrant a visit to your doctor just to make sure theyre not due to something serious.
You may be more likely to get one of the conditions that causes cramps after menopause if you:
- took estrogen for menopause symptoms
- have a family history of ovarian or uterine cancer
- got your first period before age 12
- started menopause after age 52
- used an IUD to prevent pregnancy
Think about whether you have any of these risk factors. Then, discuss them with your doctor.
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Home Remedies And Lifestyle
Eating a balanced diet may help with cramps.
Research has found that diets with high levels of red meat, processed foods, sweets, dairy, and refined grains are associated with higher estrogen levels. These dietary patterns have also been associated with increased risks of breast cancer and obesity.
Try healthier eating, focusing on the following foods:
- Whole grains: brown rice, whole-grain bread, oatmeal
- Vegetables: broccoli, spinach, carrots, sweet potatoes, Swiss chard, Brussels sprouts
- Legumes: beans, peas, lentils
- Fruits: apples, mangoes, berries, oranges
You should also try to:
- Avoid caffeine and alcohol.
- Take a warm bath or place a heating pad on your lower abdomen or back to help alleviate the pain from severe cramps.
- Incorporate physical activity into your day as exercise improves blood circulation and reduces cramps.
Hormone Therapy And Uterine Fibroids
The use of hormone therapy after menopause is associated with a greater risk for a fibroids diagnosis, as reported in a 2017 peer-review article of most studies to date. The risk of surgically confirmed fibroids increased up to sixfold in people using estrogen or combined estrogen-progestin therapy compared with nonusers.
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Managing Endometriosis After Menopause
As the hormones that trigger endometriosis drop sharply after menopause, it figures that most women will experience lesser symptoms after they begin to go through menopause. However, according to redhotmamas.org, this isnt always the case.
Some women choose to take hormone replacement therapies to combat the uncomfortable symptoms of menopause, which can include hot flashes, night sweats, weight gain and vaginal dryness. Women who do this are at risk of reigniting their endometriosis as hormones such as estrogen and progesterone are pumped back into the body.
Menopause may stop future endometrial tissue from becoming dislodged and causing lesions, but it wont do anything to diminish pain caused by existing lesions. These will need to be surgically excised by a surgeon, skilled in removing lesions from women who have gone through menopause via laparoscopy.
If menopause has been brought on by a hysterectomy, then many of the endometriosis lesions may have been removed when the uterus and ovaries were removed. However, there may be some attached to other organs that will need to be addressed by a surgeon.
How To Prevent Endometriosis Recurrence
There are certain options for you to prevent recurrence of endometriosis, including hormonal treatment and diet modification.
1. Limit Your Ovulation
Some studies suggest that preventing ovulation helps reduce the risk of recurrenceof endometriosis. This can be done by using oral birth control and hormone replacement therapy using Lupron or others like progesterone/progestin. New findings also show that using an intrauterine device or IUD after surgery may be effective in treating endometriosis and potentially preventing recurrence. Other women choose treatments using an aromatase inhibitor, which stops the production of the female hormone estrogen and minimizes the risk of endometriosis recurrence.
2. Adjust to an Endometriosis Diet
Since estrogen stimulates endometrial growth, this concept advocates avoiding foods that could increase estrogen levels. Also, foods containing plant estrogen or “bad” prostaglandins which can be converted to estrogen should be avoided.
NOTE: It is best, however, to talk to your doctor before making significant diet changes, which might lead to other health issues.
3. Boost Immune System
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What Can I Do To Help These Symptoms
Increasing your exercise levels can help to reduce stress which can help manage menopause symptoms and can also help with weight loss. Managing your weight has lots of health benefits and can lessen symptoms of menopause as well. You could discuss with your GP about talking therapies, particularly cognitive behavioural therapy.
Endometriosis And Oestrogen Dependence
Endometriosis is a disease that affects an estimated 610% of reproductive aged women, totalling approximately 176 million women worldwide . It is defined as the presence of endometrial-like tissue in extrauterine locations and is a chronic condition associated with debilitating pelvic pain, dyspareunia, dysuria, dysmenorrhoea and infertility. However, due to a lack of reliable diagnostic tools and the non-specific nature of the symptoms, there exists a widely recognized delay in diagnosis of 810 years . Consequently, the economic impact is substantial, as chronic and debilitating pain from endometriosis may hinder work productivity, while infertility can cause major psychosocial and financial strain to affected women and their partners .
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Menopause Symptoms Following Hysterectomy
A hysterectomy can put the body into surgically induced menopause if the ovaries are also removed. Without the ovaries producing estrogen and testosterone, menopause symptoms will start to occur. While some of the endometriosis pain lessened, the increase in menopause symptoms brings new challenges for many community members.
Surgical menopause issues here and there, but mainly serious problems with vaginal cuff abscess.
I now have menopause symptoms and all the fun things that go along with that.
No More Pain After Hysterectomy
For some community members, a hysterectomy was a life-changing procedure. After the recovery, some were relieved to find that all of their menstrual and endometriosis pain had been eliminated.
I had a total hysterectomy 3 years ago and have felt no pain or any symptoms other than the occasional hot flash. Best thing I ever did.
I am living a totally new life for 5 years.
Total hysterectomy after years and years of endometriosis surgeries and not a single pain or symptom since. Best decision my doctor and I ever made!
Thank you to everyone who shared. We appreciate hearing from so many in the community! Let’s keep the conversation going!
What has your experience been?
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I Thought I Was Done Cramps After Menopause
You made it through the woods. The years of bleeding through pants, hormonal weeks, hot flashes, and the dreadedcramps.
Or so you thought.
Your days of periods are over, youve traversed your way through menopause. Youre pretty positive that *that period* of your life is over, and then BAM! Cramps. In your uterus.
If this is you, lets take a look at what could be causing cramps after menopause, and what you can do about them.
Diagnosed With Endometriosis And Pelvic Adhesions After Menopause
Dorran was diagnosed with endometriosis after menopause. Her history of gynecological surgeries includes treatment for multiple GYN conditions over the past 17 years, but she continued to have pain until she met Natalya Danilyants, MD, in 2015.
In 1999, I had an open surgery, c-section style for fibroids, Dorran said. Then seven years later, in March 2006, I had a hysteroscopy procedure for fibroids and a cyst. I went into the hospital for a ruptured ovarian cyst. I was in so much pain I couldnt move.
Even after that surgery, Dorran was still in constant pain.
I followed up with my gynecologist, but he couldnt find anything wrong, Dorran said. He diagnosed me with fibromyalgia, but that had nothing to do with the pain I was experiencing. In 2005, I became pre-menopausal. When I had the surgery the following year, I wasnt having a menstrual cycle at all, so I thought it was weird that I was having cramps, and that they were sporadic.
Still experiencing pain, nine years later, Dorran had another procedure.
In 2014 I had another hysteroscopy and they said I had adhesions, polyps and my cervix was closed, she said. I didnt understand why I was always in pain. Sometimes people are not persistent enough. I was sick for a while. I went through ovarian cancer testing. I was so stressed, wondering if the pain was a figment of my imagination.
Everything changed when Dorran met Dr. Danilyants.
Is There A Risk Of Worsening Endometriosis By Taking Hrt After Having An Oophorectomy Or Taking Medications To Cause Menopause
There is a theory that HRT contains just enough hormone to keep your bones healthy and to help with menopause symptoms and contains a low enough dose to not have an effect on endometriosis. This is called the estrogen threshold theory.
This means that it is rare for endometriosis to recur or get worse when on HRT but it is possible. It is more likely if there is a residual endometriosis and your HRT only contains estrogen.
About The Author: Dr Moona Arabkhazaeli
Dr. Arabkhazaeli joined Minnesota Women’s Care after completing a fellowship in minimally invasive surgery. About this choice of specialization, she says: “While I am well trained in all aspects of OBGYN care, I have a particular interest in abnormal uterine bleeding, endometriosis, pelvic pain, and fibroids. If surgery is needed, I have the specialized skills to offer a minimally invasive approach one which which minimizes complications and hastens recovery allowing patients to return to their lives more quickly.”
Dr. Moona’s specialization in minimally invasive surgery is a perfect example of the emphasis Minnesota Women’s Care has on offering solutions to women that provide the greatest opportunity for recovery with the least amount of pain.
If you are interested in booking an appointment with Dr. Moona for endometriosis treatment or other condition, call Minnesota Women’s Care at or click Book Now.
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Endometriosis: True Or False
For each question, choose the best answer. The answer key is below.
Visanne – one of the newer medications against endometriosis. Has not stopped my endometriosis from growing into the bowel.
March is Endometriosis Awareness month, where many events and conferences are held worldwide.
Update: October 2012
My abdominal and period pain is increasing, and the adenomyoma cysts are getting bigger. Doctors are adding Visanne to my medications, to try to slow or halt the adenomyosis growth. It’s still too early to tell how well, or even if, this will work.
Update: November 2012
Two surgeons are now concerned that the endometriosis has returned, this time it’s interfering with my digestive tract – the sigmoid colon and rectum. I’m currently undergoing a barrage of tests to get a diagnosis for my worsening digestion symptoms.
Update: February 2013
Update: April 2013
Update: February 2015
Endometriosis never goes away, even if you don’t ignore it!
Case Reports Of Postmenopausal Endometriosis In Women Without Estrogen Intake Or Signs Of Endogenous Estrogen Production
Only seven case reports could be collected, and ten surgeons did not remember having seen such cases.
A 72-year-old woman with spontaneous menopause at age 54 was referred for increasing pelvic pain. She had her menarche at 11years and did not have antecedents of dysmenorrhea, dyspareunia, dysuria, dyschezia, endometriosis, nor infertility. Her medical, surgical, and gynecological history was uneventful except a diverticulitis and a volvulus 6years before. She had never taken hormone replacement therapy , and the vaginal epithelium was atrophic. The gynecological exam and a transvaginal ultrasound confirmed a normal uterus and ovaries. However, it also showed a 1-cm arciform thickening at the insertion of the right uterosacral ligament and a 24-mm nodule at 11cm from the anus, on the recto-sigmoid, infiltrating the muscularis and affecting 15% of the circumference of the bowel. In the absence of other signs of malignancy, a laparoscopy was performed with a total hysterectomy, bilateral salpingo-oophorectomy, a segmental resection of the bowel, and a resection of the retro-cervical and right pararectal nodule. The pathology revealed active endometriotic glands and stroma in the retro-cervical and right pararectal nodules. The bowel lesion had fibrosis secondary to diverticulitis. Recovery was uneventful, and she was discharged on day 5. After 4 weeks, she returned to her normal activities and is pain free.
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The Impact Of Hormone Replacement Therapy In Women With A History Of Endometriosis
The recently published guidelines on menopause management have no statements of endometriosis symptoms . The use of HRT raises concerns about disease reactivation and recurrence of pain and need for surgical treatment, and even malignant transformation of residual endometriosis. The risk of recurrence with HRT is considered to be linked to residual disease after surgery. The data regarding hormone therapy regimens is scarce. Continuous combined estrogenprogesterone treatment or tibolone, in patients with or without hysterectomy, is considered to carry a lower risk of disease recurrence, compared with estrogen-only regimens, but larger studies are required in order to prove the safety and efficacy. Management of potential recurrence is best monitored by awareness of the possibility of symptom recurrence. Patients with contraindication or who refuse hormonal treatment should be offered alternative pharmacological treatment for menopausal symptoms and for skeletal protection, if indicated. Herbal products should be avoided as some may contain estrogenic compounds and their efficacy is uncertain . The risk of malignant transformation of endometriosis in women with a history of endometriosis who received HRT remains a matter of debate. Long-term follow-up studies are needed to evaluate the risk of an adverse outcome. Further studies are mandatory in order to determine the optimal management of menopause in women with endometriosis .
Treatment Of Ovarian Cysts After Menopause
Treatment options may involve surgery to remove the cysts or other treatments for health conditions that may be causing them. Surgery, including ovary removal, may be recommended for postmenopausal women with large, non-simple cysts and other risks factors, such as history of ovarian or breast cancer.
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Does Menopause End Endometriosis
No one will ever say that being a woman is easy. With all of the health concerns and procedures that we go through, its a testament to our strength. Unfortunately, one very painful and all too common health problem that women face is endometriosis . For many of us, endometriosis is just something that we have to live with routinely. In fact, many women may not even know that they have the condition. However, if there is one major silver lining it is the fact that menopause can help ease up some of these symptoms tremendously .
What is endometriosis?The term endometriosis is derived from endometrium. In a healthy woman without endometriosis, this tissue is the material that lines the uterus. However, endometrium can begin to grow in other areas of a womans reproductive system including the fallopian tubes and ovaries as well as the outside of the uterus. The tissue can even spread to the bladder and bowel. This tissue will actually bleed just like the regular lining of the uterus does during your monthly period. However, the tissue cannot be shed by the body in the same ways so it builds up over time. When it is attached to other parts of the body, this can cause, at a minimum, severe irritation. At its worst, endometriosis can cause excruciating pain and inflammation as well as the development of scar tissue and can hurt a womans chances of getting pregnant.
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Endometriosis What Is It And How Do I Know If I Have It
Most women have heard of the menopause. They fear it, but for a select few women the menopause is a relief and a respite from the years of agony and pain from endometriosis that few people seem to understand.
Endometriosis is the reason that thousands of women each year have the menopause induced temporarily with medicines or permanently with surgical removal of the womb and ovaries. The disease is characterised by the presence of cells in areas outside the womb such as the ovaries and surfaces of the pelvis, bowel, and bladder. It affects up to ten percent of females during their reproductive years causing higher levels of pain in and outside of their menstrual cycles together with painful intercourse and difficulties falling pregnant. If there was a condition that made 10% of mens testicles hurt, with pain during intercourse, there would be a river flowing out of my GP surgery doors from the volume of male tears being shed in the waiting room.
Its widely acknowledged that pain is highly subjective with a difficult basis for comparison and considering that most women suffer from a degree of pain during their periods endometriosis sufferers assume theirs is the same as everyone else. Its not.
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