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Endometriosis symptoms after menopause


Endometriosis Stage Two

Endometriosis is often associated with younger women and those of reproductive age, but many are surprised to learn that it can still cause symptoms even after menopause. While some women find that their symptoms improve as they transition into menopause, others continue to experience endometriosis related flare ups and pain, discomfort, or other challenges, especially when taking hormone replacement treatment (HRT).


Understanding how endometriosis behaves after menopause is key to managing it effectively. In this article, we’ll explore the symptoms that can persist or develop in older age, the impact on the bowel and bladder, and the available treatment options for post-menopausal women living with endometriosis.


What happens to endometriosis after menopause?


When menopause arrives, many women are hopeful that their endometriosis symptoms will come to an end, as the hormonal changes often associated with endometriosis decrease. However, for some, the condition doesn’t disappear as expected, leaving them with questions about why they still feel discomfort.


Can you still have symptoms post-menopause?


Yes, it is possible to still experience endometriosis symptoms after menopause. Although menopause reduces the production of oestrogen- a hormone that fuels endometriosis, endometrial tissue that has already formed can remain and continue to cause symptoms. It’s a bit like a fire that’s been smouldering for years: even though the fuel of the hormones is reduced, the remnants of that fire (the endometrial tissue) can remain and cause pain or discomfort.


Many women notice that while their symptoms may lessen, they don’t completely disappear. You might still experience pelvic pain, discomfort during bowel movements, or other signs that the condition is lingering.


Does endometriosis go away after menopause?


For some women, endometriosis does improve significantly or even resolve after menopause, but for others, it remains an ongoing challenge. Endometriosis doesn’t simply vanish with menopause; instead, it tends to "quieten down" like turning down the volume on a radio- you still notice it, but it’s not as disruptive as it was before.


However, in some cases, women may continue to experience symptoms because the endometrial tissue already present can still cause inflammation and pain. If hormone replacement therapy (HRT) is being used to manage menopausal symptoms, it can sometimes aggravate endometriosis by reintroducing oestrogen into the body.


Why some women experience endometriosis symptoms in later life


There’s no single answer, but one reason could be the residual endometrial tissue that remains in your body. Over time, this tissue may continue to cause problems, especially if adhesions (scar tissue) have formed, binding organs together.


Another factor is hormone replacement therapy (HRT). While HRT can be a great relief for managing menopausal symptoms like hot flushes and night sweats, it can also trigger endometriosis flare-ups by providing the oestrogen that endometrial tissue thrives on. If you're on HRT, it’s worth discussing with your doctor whether it could be contributing to your symptoms.


The persistence of endometriosis after menopause can feel unfair, especially when many expect the condition to resolve. But the key is understanding that with the right management and treatment plan, you can continue to live comfortably and keep symptoms under control.


Symptoms of endometriosis in older age groups


As you age, the symptoms of endometriosis can evolve, especially after menopause. For some, they may fade, but for others, these symptoms can persist or even feel different than they did during their reproductive years. Understanding what endometriosis feels like after menopause can help you make sense of what’s happening with your body and guide you toward the right treatment options.


What does endometriosis feel like after menopause?


After menopause, endometriosis can feel a little different than it did before. While the intense cramps that used to come with your period may have eased up, you might still experience pelvic pain. Some women describe it as a dull, lingering ache, while others feel sharper pain, especially around the lower back or abdomen.


For some, it can be like an echo of what they experienced during their menstrual cycles. The pain isn’t necessarily tied to menstruation anymore, but the endometrial tissue left behind can still cause discomfort. This can also lead to bloating, discomfort during bowel movements, or even pain during sex. Even though the hormonal swings of your menstrual cycle have stopped, the impact of the tissue remains.


Common symptoms of endometriosis in post-menopausal women


Post-menopausal endometriosis doesn’t look exactly the same for everyone, but there are some common symptoms that many women experience. These include:


  • Pelvic pain: As mentioned earlier, this can range from mild to more severe and may occur sporadically or consistently.

  • Bloating: Often referred to as "endo belly," bloating can persist even after menopause and may be triggered by diet or bowel movements.

  • Painful bowel movements or urination: If endometrial tissue is near the bladder or bowel, it can still cause discomfort or pain, particularly during these functions.

  • Fatigue: Endometriosis can leave you feeling tired and worn out, even after menopause. It’s more than just feeling a little sleepy- it’s the kind of fatigue that leaves you drained for no apparent reason.


These symptoms can be frustrating, especially if you thought they would ease up after menopause. But knowing what to expect and recognising that these symptoms are part of post-menopausal endometriosis can help you better manage them.


Why do I feel sick all the time with endometriosis?


If you're feeling constantly unwell with endometriosis, you're not alone. Endometriosis doesn’t just affect your reproductive system- it can have a knock-on effect on your entire body. The chronic inflammation caused by endometrial tissue can leave you feeling unwell, almost like you're fighting off a lingering illness.


Endometriosis-related inflammation can also trigger nausea, making you feel queasy or unsettled. For some, the pain and discomfort can lead to digestive issues, and even affect your mood, leaving you feeling run down both physically and emotionally. It’s like having an underlying flu that never quite goes away- draining your energy and making everyday life feel more difficult.


Feeling this way isn’t something you just have to "put up with." There are treatments that can help manage the symptoms and improve your quality of life, so it’s worth talking to your doctor about how you can feel better. It's also important to consult your doctor so they can rule out other possible causes that could be contributing to your underlying feelings of illness and/or nausea.

Bowel and bladder endometriosis after menopause


After menopause, the way endometriosis affects your body can change, particularly when it comes to your bowel and bladder. While some women find their symptoms improve, others may experience ongoing issues due to the presence of endometrial tissue in these areas. Additionally, menopause itself brings about changes in your body, such as an increased susceptibility to urinary tract infections (UTIs), which can complicate bladder symptoms [1].


How bowel endometriosis can affect you after menopause


Bowel endometriosis can continue to cause symptoms after menopause, but the hormonal changes in your body may alter the intensity or frequency. Since oestrogen levels drop after menopause, some women may notice their bowel symptoms improve. However, for those with more extensive endometrial tissue in the bowel, symptoms like pain, bloating, and irregular bowel movements can persist [2].


What’s different in post-menopausal women is that symptoms can be more difficult to attribute to endometriosis. Conditions like irritable bowel syndrome (IBS) or general digestive issues often become more common with age, which can blur the lines between what’s causing your discomfort. For instance:


  • Constipation or diarrhoea may still occur, but they might also be linked to dietary changes or slower digestion associated with ageing [3].

  • Pain during bowel movements can continue, particularly if adhesions (scar tissue) have formed between the bowel and other organs.

  • Bloating might feel different post-menopause, as it can also be linked to other digestive changes during ageing.


The challenge with post-menopausal bowel endometriosis is recognising that, even without the hormonal fluctuations of a menstrual cycle, endometriosis can still have a lingering impact on your digestive health.


Bladder endometriosis: symptoms and challenges in post-menopause


Bladder endometriosis can also present unique challenges after menopause. While the hormonal reduction of menopause may slow the growth of endometrial tissue, existing tissue can still cause bladder irritation. This may lead to symptoms similar to urinary tract infections (UTIs), such as:


  • Frequent urination: A common post-menopausal symptom due to hormonal changes affecting bladder control, but also a sign of bladder endometriosis [4].

  • Painful urination: This burning or sharp pain may feel like a UTI but can be a sign of endometrial tissue affecting your bladder [5].

  • Bladder pressure: A sensation of heaviness, which may be related to both bladder endometriosis and general post-menopausal changes [4].


What makes bladder endometriosis more complex after menopause is the increased risk of actual UTIs. Women are more susceptible to UTIs post-menopause because the natural drop in oestrogen can thin the lining of the bladder and urethra, making infections more likely [6].


If you’re on hormone replacement therapy (HRT), it can sometimes aggravate existing endometriosis, potentially triggering a flare-up of symptoms similar to those you experienced pre-menopause [7].


HRT, by reintroducing oestrogen into the body, can stimulate any remaining endometrial tissue, including that around the bladder. This means that while HRT can be highly effective in managing other menopausal symptoms, it may also lead to a resurgence of bladder endometriosis symptoms, making the management of both conditions more challenging [7].


In short, while menopause might lead to improvements in some endometriosis symptoms, the effects on the bowel and bladder can linger, and managing these symptoms post-menopause often involves addressing both the lingering effects of endometrial tissue and the natural changes brought on by ageing.


Endometriosis after menopause and hysterectomy


A hysterectomy is often thought of as the ultimate solution to endometriosis, but for some women, symptoms can persist even after this procedure. This can be particularly confusing when it occurs post-menopause. Below, we’ll explore why endometriosis might still cause trouble after a hysterectomy and how it can be managed.


Can you still have endometriosis symptoms after a hysterectomy?


Yes, it is possible to still experience endometriosis symptoms after a hysterectomy, even after menopause. While a hysterectomy removes the uterus, endometriosis can affect other areas, such as the ovaries, bowel, bladder, or pelvic lining. If only the uterus is removed and the ovaries are left in place, oestrogen production can continue, potentially stimulating any remaining endometrial tissue.


Even if the ovaries are also removed (in a procedure known as an oophorectomy), there can still be endometrial tissue left behind. This is known as residual endometriosis, and it can continue to cause pain and other symptoms, as the tissue can still become inflamed even without a uterus. In some cases, scar tissue from the surgery can also contribute to pelvic pain, further complicating recovery.


To use a garden as an analogy- if you remove the main plant (the uterus), it doesn’t always mean you’ve eliminated the roots (endometrial tissue). If those roots remain, they can continue to cause problems.


Managing endometriosis symptoms after hysterectomy


Managing endometriosis symptoms after a hysterectomy requires a slightly different approach, especially if you’ve already gone through menopause. Since oestrogen is often the driving force behind endometriosis, treatments will generally focus on minimising its effects or addressing the pain directly.


Here are some common management strategies:


  • Hormone Replacement Therapy (HRT): While HRT is commonly prescribed to help manage menopausal symptoms, it can sometimes reactivate endometriosis in women who still have residual tissue. If you’re on HRT and experiencing pain, your doctor may adjust the dosage or explore non-hormonal alternatives [8].


  • Pain management: Over-the-counter painkillers or prescription options like anti-inflammatory medications can help control discomfort. For more severe pain, nerve blocks or injections may also be used.


  • Surgery: If residual endometrial tissue is identified, additional surgery may be recommended to remove it. This is particularly relevant if the pain is coming from areas like the bowel or bladder, where the endometrial tissue is still active [9].


  • Pelvic floor therapy: In cases where the pain is due to scarring or muscle tension after surgery, pelvic floor physical therapy can help relieve discomfort by improving muscle function and reducing tension in the pelvic area.


Managing post-hysterectomy endometriosis can be challenging, but the key is addressing both residual endometrial tissue and any other factors that may be contributing to ongoing pain. Working closely with your healthcare provider to develop a tailored plan will ensure the best approach for your specific symptoms and needs.


Treatment for endometriosis after menopause


Treating endometriosis after menopause can be a bit different from treating it during your reproductive years. The focus often shifts toward managing lingering symptoms and addressing any existing endometrial tissue. The good news is that there are several treatment options available, both through the NHS and private healthcare, which can help alleviate discomfort and improve your quality of life.


Endometriosis after menopause: NHS vs private treatment options


If you’re dealing with endometriosis after menopause, you have access to treatment options through both the NHS and private care. The key difference between the two often comes down to waiting times and the range of treatments available.


  • NHS: The NHS provides a comprehensive approach to endometriosis treatment, including pain management, hormonal therapies, and surgical options where necessary. While the NHS offers high-quality care, waiting times for specialist appointments or surgeries can be longer, especially for non-emergency procedures. However, the treatment you receive will be based on best practices and national guidelines [10].


  • Private care: Opting for private treatment can offer you faster access to specialists, shorter waiting times for diagnostic tests like MRIs or robotic procedures, and more flexibility in choosing a specific consultant. Private care may also offer more personalised treatment plans, especially when it comes to advanced surgeries or cutting-edge treatments that may not be readily available through the NHS [11].


The decision between NHS and private care comes down to personal preference, timing, and financial considerations. Both paths offer effective treatment options, so it’s about finding what works best for you.


Hormonal and non-hormonal treatment options


After menopause, the body produces less oestrogen, which often reduces the severity of endometriosis symptoms. However, for some women, residual endometrial tissue can still cause pain or other symptoms. There are both hormonal and non-hormonal treatment options available to manage this.


  • Hormonal treatments: Hormone Replacement Therapy (HRT) is commonly prescribed to manage menopausal symptoms like hot flushes and mood swings, but it can also impact endometriosis. Since HRT reintroduces oestrogen into the body, it can potentially reactivate dormant endometrial tissue, leading to pain or other symptoms. In these cases, your doctor may adjust your HRT regimen, use a combined approach (oestrogen and progesterone), or switch to non-hormonal treatments [12].


  • Non-hormonal treatments: For those who wish to avoid hormone therapy or for whom HRT is not suitable, non-hormonal treatments can help manage symptoms. These options include:


    • Pain relief: Over-the-counter medications like ibuprofen or prescription anti-inflammatories.

    • Nerve pain medications: In cases where pelvic nerve pain is a significant factor, medications designed to target nerve pain, such as gabapentin, may be recommended.

    • Lifestyle modifications: Exercise, pelvic floor therapy, and dietary changes can also play a role in managing endometriosis symptoms post-menopause.


Surgical treatments for endometriosis in older women


In some cases, surgery may still be necessary to remove residual endometrial tissue or address adhesions that are causing pain or other complications. This can be particularly important for women experiencing bowel or bladder endometriosis, or where non-surgical treatments haven’t been effective.


  • Laparoscopic surgery: This is the most common surgical approach to treating endometriosis, allowing surgeons to remove or destroy endometrial tissue through small incisions. For post-menopausal women, this surgery can help alleviate persistent symptoms and improve quality of life [13].


  • Robotic surgery: similar to laparoscopic surgery but with even more precision, smaller incisions and a faster recovery time.


  • Hysterectomy: For women who have not yet had a hysterectomy and are experiencing severe symptoms, this procedure may be considered. However, it’s important to note that even after a hysterectomy, some women may continue to experience symptoms due to residual endometrial tissue.


  • Adhesiolysis: This surgical procedure focuses on removing adhesions (scar tissue) that may be causing pain by binding organs together. Adhesiolysis can be particularly beneficial if endometriosis has affected the bowel or bladder [14].


Surgical treatments are generally considered when other options haven’t provided sufficient relief, and your healthcare provider will help guide you through the best options based on your symptoms and overall health.


Living with endometriosis after menopause


Emotional and physical Effects


Living with endometriosis can take a toll on both your body and your mind, and this doesn’t necessarily stop after menopause. The physical symptoms, such as chronic pelvic pain, bloating, or bladder issues, can make everyday activities feel exhausting. Even simple tasks, like walking or sitting for long periods, can leave you feeling drained.


But the impact of endometriosis goes beyond physical discomfort. Emotionally, dealing with persistent pain or health challenges can lead to feelings of frustration, anxiety, or even depression. You might find yourself feeling “off” or overwhelmed, especially if you’re juggling the hormonal changes of menopause with ongoing endometriosis symptoms. Some women even feel a sense of isolation, thinking they should be "past" these health issues once menopause begins.


Endometriosis can affect your quality of life in very real ways- interfering with your ability to work, maintain social relationships, or enjoy activities that once brought you joy. The longer these symptoms persist without treatment, the more challenging it can become to keep up with daily responsibilities. In some cases, it may even impact your financial stability, as taking time off work or reducing hours becomes necessary to manage the pain.


Managing symptoms and finding support


The good news is that you don’t have to live with these symptoms indefinitely. Seeking the right treatment can dramatically improve your quality of life. Whether it’s hormonal therapies, pain management, or surgery, addressing the root of your symptoms can help you regain control and start feeling like yourself again.


Not seeking treatment, however, can lead to prolonged discomfort and reduced mobility. This can affect your ability to stay active, engage in social events, or even perform day-to-day tasks like grocery shopping or caring for loved ones. You might find yourself missing out on activities you enjoy or being unable to meet the demands of your work.


By pursuing treatment, you open up the possibility of a life with far less pain and greater freedom. Imagine being able to plan your day without worrying about when the pain will strike, or being able to work, travel, or simply spend time with family without physical limitations holding you back. Treatment can offer relief, allowing you to get back to the things that matter most to you.


Finding the right support is important as well. Speaking to a specialist, joining a support group, or working with a physiotherapist are all ways to manage your symptoms and find emotional relief. Remember, you're not alone in this journey, and connecting with others who understand what you're going through can make a world of difference.


With the right treatment and support, living well with endometriosis after menopause is absolutely possible. It’s about taking control of your health and giving yourself the opportunity to live more comfortably, confidently, and fully.


Conclusion


Living with endometriosis after menopause can feel like an unexpected burden, especially when you hoped those symptoms would disappear. But with the right treatment and support, you don’t have to let the condition dictate your life.


Whether you’re dealing with persistent pain, digestive discomfort, or bladder issues, there are effective solutions available to help you manage your symptoms and improve your overall quality of life. Seeking timely treatment can prevent your symptoms from worsening and help you regain the freedom to enjoy your daily activities without constant discomfort.


How Rylon Clinic can help


At Rylon Clinic, we understand the unique challenges of managing endometriosis after menopause. Our team is here to support you every step of the way, offering personalised care and expert advice to ensure you receive the right treatment for your needs. Whether you require hormonal or non-hormonal treatments, surgical options, or pain management strategies, we work with you to create a tailored plan that addresses your specific symptoms.


If more advanced care is needed, we also have close ties with endometriosis specialists and can arrange seamless referrals, ensuring you get the expert help you need without unnecessary delays. Our goal is to help you live comfortably, with less pain and more confidence, so you can get back to doing the things you love.


At Rylon Clinic, you don’t have to manage endometriosis alone—our compassionate team is here to provide the care and support you deserve.


References


[1] NHS, UTIs in Menopause


[2] Endometriosis UK, Endometriosis Symptoms and Menopausehttps://www.endometriosis-uk.org/


[3] Mayo Clinic, Bowel Endometriosis Symptoms


[4] AAGL, Bladder Endometriosis and Menopause


[5] BSGE, Bladder and Bowel Endometriosis


[6] Cleveland Clinic, Menopause and UTI Risk


[7] BSGE, HRT and Endometriosis

[8] BSGE, Hormone Replacement Therapy and Endometriosis


[9] Mayo Clinic, Endometriosis After Hysterectomy


[10] NHS, Endometriosis Overview and Treatmenthttps://www.nhs.uk/conditions/endometriosis/treatment


[11] Endometriosis UK, Private Treatment for Endometriosis

[12] BSGE, HRT and Endometriosis

[13] Mayo Clinic, Endometriosis Surgery


[14] AAGL, Adhesiolysis in Endometriosis Treatment




Mr Osama Naji

Author: Mr Osama Naji


Mr Naji offers a “one-stop” gynaecology clinic for instant detection of various gynaecological cancers as well as providing all the diagnostic and treatment services needed under one roof.



Mr Naji provides advanced gynaecology scanning which is essential when conducting any gynaecology consultation, he is bilingual in English and Arabic and has an NHS base at the highly reputable Guy's and St Thomas' Hospital in London.

He is passionate about raising awareness of various subtle signs and symptoms of gynaecological conditions that are often overlooked by patients.



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