Endometriosis in menopause was first recognized over fifty years ago. But, because it is reported in only about 2-5% of women with endo, it is simply not discussed much. The actual percentage may be higher, but the talking points still focus on endometriosis somehow going away after menopause. This is simply not true in all endo patients; in some cases, endo can even start after menopause.
Unfortunately, there is still much unknown about endometriosis after menopause. Some studies have shown that the severity of symptoms may lessen with age. In contrast, others have found that endometriosis can worsen after menopause, especially when you consider adenomyosis of the uterus which can persist for decades into menopausal years. So, managing the symptoms for many women suffering from this condition becomes a lifelong battle. Suppose you are experiencing pelvic pain or intestinal symptoms that may be related to endometriosis near or after menopause. In that case, it’s important to talk to your doctor about your options for accurate diagnosis and treatment.
Managing Endometriosis After Menopause
Whether it be endometriosis resolving or the effects of prior surgery, scarring is one of the normal processes your body uses to heal. Either persistent active endo or adenomyosis or the scars or fibrosis on various organs and the peritoneum can cause persistent symptoms. Assuming you do not take estrogen replacement with a known history of endometriosis, estrogen in your body still exists in varying amounts because your fat cells convert other hormones or toxins into estrogen. On top of that, the amount of estrogen required to make endo grow varies between individuals, and estrogen is not the only molecular driver to make endo grow. For all these reasons, pain from endo persists into menopause in at least 2-5% of patients. The treatment overlaps regardless of why the symptoms may be present but is not exactly the same.
Reducing the severity of endometriosis symptoms after menopause
What about surgery? Since accurate blood test biomarkers are still not available, surgery can’t be ignored as a possible part of the plan. Regardless of whether it is persistent endo or newly developing endo, scars from endo healing or progressive scarring from prior excisions, expert evaluation for possible surgical intervention should be a cornerstone in planning. Based on a risk vs. benefit discussion with an expert surgeon, a consult with an expert is the best way to determine what is going on after menopause. This consult can help form the best treatment plan beyond the excision of endometriosis, scar, or even possible hysterectomy. If, for example, persistent adenomyosis is the cause of your pain, then surgery may be hands down the best option to eliminate the pain.
If active endo is responsible for the symptoms, it is possible to reduce symptom severity through some general adjustments. This adjustment includes diet and lifestyle modifications. Reducing stress levels by finding calming activities like yoga or meditation, eating an anti-inflammatory diet high in fiber (to absorb excess estrogen in the gut), and engaging in regular physical activity can all help ease endometriosis pain in some. These are general recommendations and depend on what else, like SIBO or irritable bowel syndromes, may be going on.
Combining mainstream medication options with integrative support could significantly reduce the discomfort of endometriosis symptoms post-menopause, allowing many women a chance to reclaim their quality of life. The following are some specific considerations.
Taking Hormone Replacement Therapy (HRT)
Taking hormone replacement therapy (HRT) is an important treatment decision. HRT is a form of medication that uses hormones to relieve menopausal symptoms. If the uterus is still present, then both estrogen and progesterone are required in order to reduce the risk of uterine cancer. If not, then estrogen replacement therapy (ERT) alone may be better because this means a lower risk of developing breast cancer. However, it is controversial whether HRT or ERT can make endo grow. Scientific data suggests that HRT may be better in this regard, but this is not clear-cut. Similarly, it is unclear if herbal or plant-based estrogen replacement is safe, and, based on complex molecular biology factors, it is probably different in each individual. Always keep in mind that your body is never in a zero-estrogen state because your fat cells convert other hormones into estrogen, and toxins you are constantly exposed to (xenoestrogens) can also factor in.
Taking Pain Relievers Like Ibuprofen or Acetaminophen
Taking pain relievers like ibuprofen or acetaminophen might be an effective way to manage intermittent mild to moderate endometriosis pain. Of course, there are side effects that are usually mild, which must be balanced when compared to the benefit of longer-term use. A pain specialist may recommend using stronger medications such as narcotics, gabapentin, or related drugs. Generally, it is not recommended to take any of these medications continuously. More importantly, relying on pain medications alone is like putting a band-aid on a gaping wound without repairing the wound. A better strategy is to deal with the root cause and try to correct it. Determining if the root cause for pain is endo or adenomyosis related in menopause requires a consult with an endometriosis specialist and, ideally, one who specializes in peri and postmenopausal endo.
Reducing Stress with Relaxation Techniques Like Yoga or Meditation
Yoga and meditation have been demonstrated to effectively mitigate stress levels, which may reduce endometriosis-related symptoms. How this happens is poorly understood, but it may be mediated by cortisol level alterations or epigenetic regulation of pain receptor-related gene expression. This is a very subjective area and hard to study objectively, but research is ongoing. One can’t go wrong with this option because it does not carry risk and can benefit your health in multiple ways.
Exercising Regularly
Regular exercise is a meaningful way to maintain physical and mental health, whatever your age or circumstances. For endometriosis patients, in particular, being physically active can help reduce inflammation and adapt the body’s response to pain. Studies have also shown that regular workouts may help endometriosis sufferers manage endocrine problems, anxiety, and stress levels. With physical exercise, endometriosis patients benefit from improved quality of sleep too. So this is another low-risk lifestyle modification that can reap many benefits.
Pelvic Floor Therapy
The inflammation from endometriosis and/or direct nerve impingement at the pelvic floor can cause pain in menopause, just like during the reproductive years. The muscles and fascia over-react and spasm, which can be relieved with pelvic floor physical therapy. In some cases, it can help with fibrosis or scar-related pain by restoring normal motion. Usually, this requires a program and is not a one-time deal, so a consultation with a pelvic floor therapist is definitely worth considering. Pelvic floor therapy may or may not be the solution for you. If pain persists, surgical options may still need to be considered to get to the root of the problem.
Don’t Suffer with Prolonged Severe Symptoms
After menopause, many women find that their endometriosis and other symptoms still impact their life significantly, even if they follow prudent diet and lifestyle modifications. If you are in this situation, don’t hesitate to speak to an endometriosis expert about the potential benefits and risks of surgery and other treatment options available. Molecular markers for endo may be coming soon, but today surgery is the only way to accurately diagnose endo. Especially when pain persists into menopause or starts in menopause, other conditions may be the cause or overlapping endometriosis and adenomyosis. Surgical treatment may or may not be the right answer for you, but expert guidance and complete evaluation is better than waiting the pain out and hoping it will go away.
Get in touch with Dr. Steve Vasilev
More articles from Dr. Steve Vasilev:
Endometriosis And Menopause: Everything You Need To Know
How to tell the difference between endometriosis and ovarian cancer
Understanding the Connection between Endometriosis and Cancer
