People who have had endometriosis often don’t get enough attention or clear guidance if they are approaching menopause. Because there aren’t many good-quality studies, it can be unclear how to best manage menopause symptoms and there is no one-size-fits-all approach. We also don’t know exactly how likely it is for endometriosis to come back or turn into something more serious, especially when using hormone replacement therapy. To better support and give clearer answers, we need large, well-designed studies that can help both doctors and patients make informed decisions.

3. Is There a Cancer Risk?

Very rarely, endometriosis tissue can turn into cancer, especially in older women. This is not common, but it’s another reason why doctors keep a close eye on women with a history of the condition, especially if they start having new symptoms like pain or bleeding after menopause.

4. What Are the Other Options?

You and your specialist doctor may consider aromatase inhibitors, which are medications that block the production of estrogen in the body. Since endometriosis feeds on estrogen, lowering those levels can help reduce the activity or growth of endometriosis tissue. Aromatase inhibitors may not be suitable for long-term use and require regular bone density monitoring due to the potential for loss of bone density.

If your menopause symptoms are manageable, it’s best to try non-hormonal approaches first. These might include:

• Non-hormonal medications (some antidepressants and other drugs can help with hot flashes)
• Lifestyle changes (diet, exercise, sleep)

5. What Should I Do If I Had Endometriosis?

If you had endometriosis and are going through or already in menopause, here’s what’s recommended:

• Talk to your doctor before starting any hormone therapy.
• Let them know if you’re having any new pain, bloating, or unusual bleeding.
• Have regular check-ups just to be safe.
• Ask about other ways to manage menopause symptoms if you’re concerned about hormones.

References

Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. Published 2022 Feb 26. doi:10.1093/hropen/hoac009

Gemmell LC, Webster KE, Kirtley S, Vincent K, Zondervan KT, Becker CM. The management of menopause in women with a history of endometriosis: a systematic review. Hum Reprod Update. 2017;23(4):481-500. doi:10.1093/humupd/dmx011

Peri-menopause is defined as the transitional period leading up to menopause, marked by hormonal fluctuations and changes in menstrual cycle regularity. It begins several years before the final menstrual period and continues until one year after. Typically starts in a woman’s mid-to-late 40s, but can begin earlier. 

Peri-menopause can cause cycle irregularity (shorter or longer cycles), symptoms such as hot flashes, mood swings, sleep disturbances, and changes in libido or Hormonal fluctuations, especially in estrogen and progesterone levels.

How does peri-menopause affect endometriosis?

Some women experience relief from endometriosis pain as estrogen levels naturally decline. Others find their symptoms worsen or persist, possibly due to hormonal fluctuations or estrogen still being produced by fat cells even after the ovaries slow down.

Unpredictable menstrual cycles can increase discomfort. 

Perimenopause often brings irregular periods, heavier or lighter bleeding, and unpredictable cycles. Women with endometriosis may experience more intense cramping and prolonged bleeding due to the presence of excess endometrial tissue outside the uterus.

Ovarian endometriomas (“chocolate cysts”) can persist.

Some people with ovarian cysts caused by endometriosis may continue to experience pelvic pain, even if their periods become irregular or stop temporarily. In some cases, endometriomas may shrink after menopause, but others require medical intervention. There is a rare risk of cancer associated with endometriomas and your doctor may discuss surgical options for this reason.

Inflammation and Scar Tissue May Cause Ongoing Pain

Even if endometriosis lesions shrink over time, scar tissue and adhesions formed by years of inflammation can cause chronic pelvic pain, particularly if organs have fused together (a condition called frozen pelvis). Some women continue to have pain even after menopause because of these structural changes.

Managing Symptoms When You Have Both Conditions

If you’re dealing with both endometriosis and perimenopause, treatment should be personalised based on your symptoms and medical history. Here’s what may help:

Tracking Symptoms and Cycles

Because perimenopause brings hormonal ups and downs, keeping a symptom journal can help you and your doctor recognise patterns and adjust treatment accordingly.

Medications and Hormone Management

Always consult your doctor before starting a new medication.

• Non-hormonal pain relief: NSAIDs (like ibuprofen) help reduce inflammation and pain.
• Hormone therapy pills or IUDs: A progestin-only IUD (like Mirena) can help regulate cycles and reduce endometriosis pain.
• Menopausal Hormone Therapy (MHT): If needed, a doctor may prescribe a combination of low-dose estrogen and progesterone to balance symptoms safely.

Lifestyle and Diet Adjustments

• Anti-inflammatory diet: Eating more fruits, vegetables, whole grains, and omega-3 fatty acids can help reduce inflammation and pain.
• Regular exercise: Gentle activities like yoga, walking, and swimming can help reduce pain and improve overall well-being.
• Stress management: Meditation, acupuncture, and deep breathing can help ease both symptoms worsened by stress.

Considering Surgery

If symptoms are impacting your life and do not respond to other treatments, a hysterectomy with or without ovary removal may be an option. Discuss hormone management post-surgery with your doctor to avoid sudden menopause complications and how these medications may interact with your symptoms.

The relationship between endometriosis and perimenopause is complex but understanding how these conditions interact can help you make informed choices about your health. If you have endometriosis and are entering perimenopause, working with a specialist gynaecologist is essential to find the best treatment approach for you.

Whether it’s hormone therapy, surgery, or lifestyle changes, there are ways to manage both conditions and improve your quality of life. You are not alone; support and treatment options are available!

References 

Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. Published 2022 Feb 26. doi:10.1093/hropen/hoac009
Alio L, Angioni S, Arena S, et al. Endometriosis: seeking optimal management in women approaching menopause. Climacteric. 2019;22(4):329-338. doi:10.1080/13697137.2018.1549213