Why menopause doesn’t always mean the end of endometriosis suffering

1.5 million women in the UK suffer from endometriosis, and for many of them, menopause might seem like the light at the end of the tunnel. But this isn’t necessarily the case. 

Hands up if you’re looking forward to going through the menopause? While it’s true that most of what we hear about menopause symptoms makes for pretty miserable reading, there could be an upside we’ve been missing: the potential for relief from endometriosis symptoms. 

Amongst the plethora of painful issues some women have to face, endometriosis can be one of the most debilitating. Sufferers report symptoms including immense pelvic pain, nausea, vomiting, fatigue and low mood (to name a few). It might be comforting to think that the onset of menopause or perimenopause will alleviate these issues. But is it really as simple as this? 

“Endometriosis is a condition where endometrial-like tissue (tissue similar to the lining of the uterus) is present in places outside of the uterus or womb,” explains NHS GP and women’s health specialist Dr Aziza Sesay.“It can spread onto the ovaries, fallopian tubes, bowels and even as far as the lungs.”

Endometriosis is relatively common, affecting one in 10 women and people with gynaecological organs. “In the UK, a similar proportion are affected by endometriosis as diabetes, yet, on average it takes about eight years to diagnose,” says Dr Sesay. 

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How does endometriosis affect women?

Endometriosis is about much more than just your period, causing a variety of symptoms throughout the menstrual cycle. These can include “severe period pains in the stomach and/or back, painful intercourse, pain on urinating or opening bowels during your period, heavy bleeding during periods, fertility problems and more,” says Dr Sesay.

One of the reasons endometriosis can be so difficult to diagnosis is that the symptoms can vary considerably between individuals, and many other conditions can cause similar symptoms. However, Dr Sesay emphasises that endometriosis symptoms “can be severe enough to have a profound impact on an individual’s life”. 

“Endometriosis can be very debilitating and limiting but for some, it may not cause any symptoms at all – it’s a spectrum,” she says. “If you are struggling with symptoms, please speak with your doctor to have more assessments to ascertain the cause.”

How does menopause affect endometriosis symptoms?

For the sake of clarity, here’s a quick recap on what menopause and peri-menopause is. 

“Perimenopause means ‘around menopause’, and refers to the time during which the body makes the natural transition to menopause,” explains Dr Sesay. “It can last between four and eight years. It is the start of deteriorating ovarian function, which basically means that the ovaries are not producing sex hormones such as oestrogen in the same way as before. Menopause is the point in time when periods have ceased completely for 12 consecutive months.”

Given that endometriosis is caused by the lining of the womb attaching in places where it shouldn’t, you might assume that the menopause would put an end to it, since the womb stops growing and shedding its lining at this time. 

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“In the majority of cases, we would expect that endometriosis symptoms would improve and possibly disappear entirely once menopause has been reached,” agrees Dr Sesay.

“Endometriosis is a highly oestrogen-dependent condition, therefore logically, if the levels of oestrogen drop, we expect and do generally find that the symptoms of endometriosis also tend to ease.”

However, as with most women’s health issues, the reality isn’t quite as straightforward.

“Everyone is different, and it is difficult to predict how our bodies will react to both peri- and post menopause,” Dr Sesay continues. “It was previously thought that endometriosis was a condition that only affected women of reproductive ages, but there are documentations that peri- and postmenopausal women have been found to suffer with endometriosis – even including those who had never previously been diagnosed with endometriosis.”

Perimenopause can be a trigger for endometriosis

Some studies have found that endometriosis was more prominent in perimenopausal people compared to postmenopausal patients. “Indeed, symptoms can be worse in perimenopausal women,” says Dr Sesay. “This is thought to be linked to the fluctuations in hormones experienced during this stage.”

HRT can make endometriosis symptoms worse

Frustratingly, research shows that hormone replacement therapy (HRT) – which is undoubtedly excellent for relieving symptoms of the menopause – might in fact make endometriosis worse.

“There is still limited research into endometriosis and even less when it comes to its association with menopause,” says Dr Sesay. “But there can be a link between HRT and endometriosis. HRT works by boosting oestrogen levels to relieve menopause symptoms caused by fluctuating hormone levels, but since endometriosis is oestrogen-linked, taking HRT can unfortunately worsen symptoms.”

It’s important to note, again, that we’re all different, and how our bodies respond to medications is entirely individual. Dr Sesay stresses the importance of seeking medical advice if you’re struggling.

“Please don’t suffer in silence. There is no cure for endometriosis but various treatment options are available, from over the counter painkillers, psychological counselling and support to surgery,” she says. “Please always discuss your options with a doctor to reach a shared agreement of the treatment option that would suit you best.”

Images: Getty

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