Usually we expect endometriosis to go away as a woman gets to menopause, but the symptoms can persist. What really happens is that years of chronic inflammation and scar tissue that's formed don't just go away even if estrogen activity is reducing. These lesions can cause ongoing pain in women, and for others there's still some level of residual estrogen production. The adrenal glands and adipose tissue are the main culprits here, but it's different from the symptoms of inflammation and scar tissue, which are independent of ovarian function.Most hormone therapies are estrogen-based, and they can worsen the symptoms of these lesions in women. Estrogen helps in the growth of these endometriotic lesions, so there's a counterproductive effect in women with this condition. One way to reduce this risk is by using progestin-only therapies, which are a lot more beneficial, or combining the estrogen with progestin, which helps reduce some adverse effects. Patients on HRT with a history of endometriosis should be counseled properly on the choice of treatment, and also when they choose estrogen-based therapies, they should understand the risks. Knowing the risks isn't enough, but these women should be educated on possible worsening symptoms and be placed on regular clinic visits. Endometriosis has more specific symptoms in premenopausal women, like the cyclic pain. The lesions respond to the hormonal changes, and when they get inflamed and bleed during menstruation, it causes pain. In menopausal women the pain is usually constant, and bleeding isn't common. Laparoscopy is the definitive diagnostic tool, but transvaginal ultrasound scans and MRI can pick up endometriotic lesions. All these come after a good clinical history and examination from the gynecologist. Treatment is basically for the hormonal part and the symptomatic management. Hormone therapies like progestin-based medications (the most common in use), aromatase inhibitors, and gonadotropin-releasing hormone (GnRH) agonists are the three options. As a last resort, surgery may be recommended—laparotomy or hysterectomy—but there's an option of a minimally invasive laparoscopy. One of the biggest myths was already asked here, and it's the opinion that endometriosis symptoms typically go away at menopause. Yes, the hormones responsible may be going down naturally, but women suffer a lot from complications like fibrotic scar tissue and chronic inflammation.
Neuroscientist | Scientific Consultant in Physics & Theoretical Biology | Author & Co-founder at VMeDx
Answered 6 months ago
Good Day, Why are endometriosis symptoms able to persist, or even present for the very first time, after menopause? Even if estrogen levels decrease after menopause, some endometriosis lesions can produce estrogen locally, or the body can convert other hormones into estrogen. Therefore, it is possible that the disease may remain active or even appear for the first time after the cessation of menstrual periods. How does HRT affect endometriosis lesions in a menopausal woman, and what should a patient on HRT know? HRT, especially if it is estrogen only, can wake up those lesions from endometriosis and perhaps worsen symptoms. Women with a past history of endometriosis would be advised to speak to their doctors regarding combined estrogen and progestin therapy or be closely monitored while on HRT. How do the symptoms of active endometriosis in menopausal women differ from the "classic" symptoms in the premenopausal patient? Instead of usual, period-related pain, menopausal women often experience more constant pelvic or bowel discomfort. Since they are not having periods anymore, the symptoms do not follow any cycle, which may make the recognition difficult. What are the most effective diagnostic tools and treatment strategies for managing endometriosis in this specific demographic? The diagnosis is generally based on imaging, e.g. ultrasounds or MRIs, combined with meticulous examination. The treatment is directed towards pain and symptoms management, medical, and surgery when appropriate. What is the single biggest myth you would want to dispel about menopause and endometriosis? The biggest myth is that endometriosis simply goes away after menopause. Many women continue to suffer from an active disease that deserves attention and care, so one should not ignore treatment just because the menstruation has ceased. If you decide to use this quote, I'd love to stay connected! Feel free to reach me at gregorygasic@vmedx.com and outreach@vmedx.com.