Treating Endometriosis After Menopause
Management strategies for postmenopausal patients with new or recurrent endometriosis diagnoses vary. For symptomatic patients without a clinical history of endometriosis, surgery may be an option to alleviate symptoms and reduce the risk of malignant transformation. Non-surgical options such as progesterone or aromatase inhibitors have also been discussed as options, though some therapies may come with bone density concerns or other risks.
For patients with a history of endometriosis, the use of hormonal replacement therapy during menopause is widely debated. Given the estrogen-based mechanics of hormonal therapy, some researchers point to questions about its effect on symptom and disease recurrence, as well as cancer risk. However, the use of hormone replacement therapy carries many benefits for postmenopausal patients, including supporting bone health.
Some researchers suggest patients should not be denied therapy just because they have previously had endometriosis. In a review from Medicina, the authors weighed those benefits and risks documented in low-grade literature to arrive at a recommendation of using combined estrogen and progestogens rather than unopposed estrogen. Still, more research is needed in this area.
Do Symptoms Of Endometriosis Change After Menopause
Research studying postmenopausal endometriosis symptoms is limited, though a few studies are available.In one review of other studies, researchers found that deep dyspareunia and chronic pelvic pain were less common symptoms. The symptoms reported did not follow the cyclic patterns that premenopausal women commonly report, and related symptoms such as bloating also ceased.
Can I Get Pregnant If I Have Endometriosis
Yes. Many women with endometriosis get pregnant. But, you may find it harder to get pregnant. Researchers think endometriosis may affect as many as one in every two women with infertility.6
No one knows exactly how endometriosis might cause infertility. Some possible reasons include:7
- Patches of endometriosis block off or change the shape of the pelvis and reproductive organs. This can make it harder for the sperm to find the egg.
- The immune system, which normally helps defend the body against disease, attacks the embryo.
- The endometrium does not develop as it should.
If you have endometriosis and are having trouble getting pregnant, talk to your doctor. He or she can recommend treatments, such as surgery to remove the endometrial growths.7
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Choosing A Minimally Invasive Hysterectomy
For most cases of endometriosis, excision surgery is the most effective treatment. But for some cases of endometriosis in severe advanced stages, a hysterectomy that removes the ovaries may also be necessary to relieve symptoms. While a hysterectomy does not cure endometriosis, removing organs that have been damaged due to pelvic adhesions and inflammation can alleviate pain.
Im 61. I dont need these organs. I had a complete laparoscopic hysterectomy, Dorran said. After surgery with Dr. Danilyants I could tell this time was different. I dont like taking medicine. I had painkillers when I left. I got home from the surgery, I had one when I got home and that was it. I had surgery on a Thursday, rested on Friday and on Saturday I was up and doing normal stuff. Now I feel like I could run a mile. I dont feel like I just had surgery.
When I was getting ready to come back to work from surgery, I had to get my hair done. The hairdresser was amazed that I could lean back. You can see the difference after a minimally invasive hysterectomy. When I had my open surgery and had to go back to work, it took forever not to feel pain. Even the difference of walking outside, you put your foot on the cement versus walking around the house in your slippers and its jarring. It was very different this time.
Live your life pain-free. Talk to a patient advocate to get started on your health journey today.
What Are The Signs And Symptoms Of Endometriosis
The main symptom of endometriosis is pelvic pain. Pain is typically worst before or during menses and may be associated with sex, bowel movements, or urination. Endometriosis may also eventually lead to constant, chronic pelvic pain. In fact, endometriosis is found in about three quarters of women with chronic pelvic pain.
The amount of pain someone has is not always associated with how severe the endometriosis is. Some women with slight pain may have significant endometriosis, and others with a lot of pain may have just a mild. In fact, in some cases endometriosis is found in women with no symptoms at all.
In addition to causing pelvic pain, endometriosis can affect fertility. Extensive endometriosis can cause scarring and blocking of the fallopian tubes. Even mild cases can reduce the chance of getting pregnant from the normal 25% per month to around 7% per month, on average. Endometriosis is found in about one third of infertile women.
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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.
Symptoms Of Endometriosis After Menopause
The list of endometriosis symptoms after menopause can include the following:
- Pelvic pain
- Gastrointestinal problems
- Pain during sexual intercourse
Postmenopausal women should keep in mind that they are also at higher risk of autoimmune disorders – like allergies, asthma, and fibromyalgia – as well as other health conditions, such as chronic fatigue syndrome and hypothyroidism, among others.
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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.
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 .
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Natural Treatment For Postmenopausal Endometriosis
Women looking to naturally treat their endometriosis after menopause should first turn to their nutrition.
Diet has proven to have a significant influence on the risk of pelvic endometriosis. Studies have shown that increased consumption of green vegetables and fresh fruits decreases the risk of endometriosis, while beef and other red meats increase the risk.5
Moreover, dietary fiber and whole grain intake promotes a healthy balance of gut bacteria, which is necessary to properly regulate circulating estrogens and reduce inflammation. Find them in raspberries, pears, green peas, broccoli, lentils, black beans, barley, quinoa, and more.
However, while natural treatments for postmenopausal endometriosis do include dietary changes as an instrumental step toward relief, other alternative options should not be forgotten, like melatonin supplements, which are scientifically proven to reduce endometriosis-related pelvic pain.6
What Do These Medicines Do
Some of these medicines only treat the pain of endometriosis. Hormone medicines stop your periods. This may cause side effects like the ones women have at menopause, such as hot flashes and vaginal dryness. Sometimes the side effects go away if you also take an estrogen pill every day. A medicine called danazol can cause acne and facial hair.
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Does Endometriosis Pain Go Away After Menopause
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Causes Of Postmenopausal Endometriosis
Just as it is uncertain exactly what causes endometriosis in premenopause, the exact cause of postmenopausal endometriosis is also relatively ambiguous.
However, a major risk factor for endometriosis no matter one’s age is having elevated levels of estrogen in the body or a greater lifetime exposure to the hormone.
As such, in regards to postmenopause, research suggests that the presence of greater circulating levels of estrogen from phytoestrogens, plant-based estrogens, and hormone replacement therapy could contribute to the development or progression of the disease, especially when used for menopause symptom relief the years prior.3
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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 sensitivities8
- Autoimmune diseases, in which the body’s system that fights illness attacks itself instead. These can include multiple sclerosis, lupus, and some types of hypothyroidism.9
- Certain cancers, such as ovarian10 and breast cancer11
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.
Risk Of Malignant Transformation
The possible transformation of endometriosis lesions into malignant lesions and their dissemination in the ovaries, bowel, and even lungs has been described. The risk of malignant transformation of endometrioma into an ovarian cancer is estimated at 2% or 3% , and may be higher in patients receiving estrogen therapy. Furthermore, patients with endometriosis have an increased risk of other malignancies, apart from ovarian cancer .
Differential diagnosis of benign from malignant tumors in postmenopausal women is difficult. We must take into account that some endometriosis lesions may have a similar appearance to malignant disease and can cause local and distant metastases and can infiltrate adjacent tissues and organs. Age is an important risk factor for many malignancies, thus it may be questioned whether the postmenopausal endometriosis increases the risk for malignancy .
In 1997, Brinton et al. showed that patients with endometriosis seem to have an increased overall cancer risk . Some authors indicate an increased risk of ovarian cancer, calculated to be around 35% for clear cell carcinoma and 19% for endometrioid type carcinoma in women with endometriosis .
On the other hand, Somigliana et al. concluded that there is evidence to support that endometriosis should be considered a medical condition associated with a clinically relevant risk of any specific cancer .
Endometriosis Recurrence In Women On Hrt
Thirteen case reports and case series were identified reporting endometriosis recurrence in menopausal women given HRT for the treatment or prevention of menopausal symptoms. These included 17 patients between the ages of 3065 . All of the included women had undergone treatment with exogenous oestrogens in some form. was the earliest report retrieved by our search. This case was a 48-year-old Caucasian woman who presented with a 2-month history of painless haematuria and decreased urinary stream on voiding. She had undergone a total abdominal hysterectomy with bilateral salpingo-oophorectomy with endometriosis found in the specimen and confirmed by histology. She had been prescribed conjugated oestrogens following surgery and continued these for 6 years until her presentation. On physical examination, a 7 cm × 8 cm mass starting in the midline and extending to the left pelvic wall was palpated and the patient underwent cystoscopy. Postmenopausal bladder endometriosis was diagnosed histologically. Oestrogens were discontinued and intramuscular medroxyprogesterone acetate was administered for 2 months. Despite this, there was no significant alteration in the size of the mass. Shortly afterwards, due to symptom recurrence, the endometriotic lesion was removed surgically. The patient had no complaints 1-year post treatment. The authors commented that exogenous oestrogens play a role in the stimulation and development of postmenopausal endometriosis.
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Getting A Diagnosis For Endometriosis And Menopause
Endometriosis can be a bit tricky to diagnose. If cysts have formed, your doc may be able to feel them during a pelvic exam. An abdominal or vaginal ultrasound may be able to detect cysts. Docs might suggest an MRI to identify endometrial growths. Laparoscopy, where a small cut is made in the abdomen so a thin viewing tube can be inserted for the doctor to have a look at internal organs, is considered by many to be the gold standard diagnostic tool. With planning, laparoscopy can also be used to surgically treat the disease at the same time.
Two: Will Hrt Bring Endometriosis Symptoms Back
Answer: it might. Says Dr. Rebecca, HRT may or may not bring symptoms back, as it is lower dose than menstrual hormones. Many women do just fine if they wait a year or so to start. Hormones that are applied topically may also have less chance of reviving endometriosis.
Every woman needs to have a thorough conversation with a doctor about the pros and cons of taking HRT for menopause symptoms, especially if they have a condition like endometriosis.
Not all pelvic pain is endometriosis, and not every woman with endo experiences symptoms. If youre having pain during your period, and youre not sure if its just really bad period cramps or something else, talk with a doctor. You are not overreacting, you dont need to just suck it up. Pain is your bodys way of communicating a problem, so get help.
Need an doctor’s evaluation of your health? A Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.
Have you been diagnosed with endometriosis? We’d love to know how you’re doing, so please share your experience with the Gennev community by commenting below, posting in our community forums, sharing with us on our , or joining Midlife & Menopause Solutions, our closed Facebook group.
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Why Doesnt Endometriosis Go Away With Menopause
Researchers believe that at least 11 percent of women in the United States have endometriosis. Although most people who have endometriosis stop experiencing symptoms when they enter menopause, 2 percent to 5 percent continue to have the condition, research shows.
Estrogen-replacement therapy may cause ongoing endometriosis after menopause. Estrogen makes endometriosis worse by stimulating the growth of endometrial tissue. Postmenopausal women, including those in surgical menopause, may take estrogen to ease the symptoms of menopause and prevent bone loss.
Pairing estrogen with progesterone, however , can lessen the effect of estrogen. The hormones relieve the postmenopause stage, one member said who had started on the combination following a hysterectomy.
The medication Tamoxifen is used to treat breast cancer, but it has an overall anti-estrogen effect and may act like estrogen in the uterus. It may also cause endometriosis to occur after menopause.
Its important to understand that estrogen production does not completely stop with menopause, either. Peripheral fat is an excellent source of estrogen.