Dr. Steve Vasilev, MD, Gynecologist, Endometriosis Surgeon*:

One has to be very careful not to ascribe all pelvic symptoms to endometriosis (or related adenomyosis), whether you have been previously diagnosed with it or not.  So, a thorough evaluation is very important, including making sure there are no primary bowel or bladder issues going on.

Having said that, endo can flare at any point in life, even after menopause and even if you do not take hormone replacement.  In the perimenopausal years (late 40’s into early 50’s) estrogen is still being made by the ovaries; some estrogen is also coming from fat cell hormone interconversion, we all take in toxins that are xenoestrogen endocrine disruptors, and the tissues surrounding endo can also produce estrogen.  In addition, hormones are not the only driver of estrogen.  There are molecular growth drivers as well, some of which overlap with cancer-related molecular drivers (e.g. ARID1A) that can stimulate endo growth, evemn if they do not turn into cancer as they rarely can.

So, could pain after menopause be related to endo? Yes.  Could it be something else?  Also yes.   It would be prudent with new onset pelvic pain to get evaluated as soon as possible. This may likely include imaging with ultrasound, CT or MRI.  Also, blood in the stool generally leads to colonoscopy by a gastroenterologist.  The most prudent course with multiple pelvic symptoms is to get your primary to refer to gastroenterology and gynecology, and possibly urology if there are urinary symptoms (front of pelvis).  Or, if insurance allows,  make a direct appointment with at least the gastro to evaluate colon bleeding.   Endo and adenomyosis can be in the picture and an endometriosis specialist may be helpful as well but with blood in the stool, the most important part is gastroenterology evaluation.  If access is an issue, and rectal bleeding is present, a visit to the emergency department is also a consideration.

*This is not medical advice and is aimed for informational use only. Don’t hesitate to get in touch with the doctor’s office or consult your doctor for any medical questions.