🔥 Hot Topic – Endometriosis and Menopause

[Lynne_support]

Endometriosis UK Specialist Advisor Joanne Hanley is producing a series of short articles on topics that may be of interest to anyone with endometriosis.

This time the 'Hot Topic' is endometriosis and the menopause

Does endometriosis go away with the menopause?

During the perimenopause and menopause, the body produces lower levels of oestrogen until eventually the ovaries stop producing oestrogen altogether. Oestrogen is a hormone that stimulates and feeds endometriosis, so for many people their endometriosis symptoms improve and may resolve completely. For some endometriosis symptoms can continue during the menopause, this is usually when there has been a diagnosis and severe symptoms prior to menopause.

Surgical menopause (having the ovaries surgically removed, in a procedure called oophorectomy) stops the production of oestrogen. Like with a natural menopause, endometriosis symptoms for many will improve but there remains the risk that symptoms may continue, and endometriosis may remain active. This risk increases with the use of Hormone Replacement Therapy (HRT).

Managing the menopause:

A decline in oestrogen can have numerous effects on the body. For many, the menopause can be a relief especially when there is an improvement to endometriosis symptoms. For others the menopause can create new symptoms which can have a significant impact on quality of life.

Common symptoms of the menopause are:

• Hot flushes

• Night sweats

• Difficulties sleeping (insomnia)

• Brain fog

• Low mood and/or anxiety

• Vaginal dryness

• Reduced sex drive (libido).

Menopausal symptoms can occur naturally with the average age within the UK being 51. It can also occur surgically following removal of ovaries and medically, as a side effect of hormone treatments such as GnRH analogues. Unlike surgical or natural menopause, a medical menopause is temporary and reverses when hormone treatments are stopped.

HRT replaces the hormones that the body no longer produces in menopause. The two main hormones used are oestrogen and progesterone. HRT may be recommended by your healthcare practitioner, usually for those who are struggling with menopause symptoms or as a preventative for other health conditions. If experience early menopause (before the average age of menopause) then HRT can reduce the associated health risks of this, such as osteoporosis, heart disease and dementia.

Will HRT effect endometriosis symptoms?

Potentially yes, but for many HRT can be beneficial. As HRT contains oestrogen this could activate endometriosis tissue and potentially stimulate growth of endometriosis. It’s important to note that the levels of oestrogen within HRT is lower than what the body would have produced naturally so HRT is still on option for treatment and both the benefits and risks should be considered. Your GP/Gynaecologist will assess you to determine the suitability of HRT on an individual basis. If endometriosis symptoms reoccur whilst on HRT then this should be discussed with your GP/Gynaecologist, HRT treatment could be changed or ultimately stopped.

[Cailleach]

As so often, the fact that endo symptoms can continue after menopause is mentioned, but then the focus moves to HRT and endometriosis.

Those who have continuing symptoms after menopause, ( without taking HRT!) are frequently dismissed by the medical professions, even those who are supposed experts and it is very difficult to access treatment. There is only now beginning to be some recognition that endo post menopause does actually exist.

I was dismissed by the nearest BSGE who were not prepared to even see me and recommended I attend the Chronic Pain Service due to my ‘neuropathic’ pain.

It would be good to see Endo UK paying a bit more attention to this issue.

[narnian56 in reply to Cailleach]

Hi Cailleach... this post is a few months old so I'm hoping you still see this. Did you ever find a BSGE or anywhere else that took your post menopause symptoms seriously as being possibly endo related? I have a long history of severe endo. Two years on from my last period. No HRT. In fact, I'm not having any of the common symptoms related to menopause - which I'm not complaining about🙂!My pelvic pain levels and other symptoms are a bit better than they were or at least are more responsive to my cocktail of painkillers - but it's still not a normal situation to be in and I am still affected on a daily basis. I do know from an MRI taken about 4 years on from my last excision operation, that a significant amount of disease recurred. So, it's definitely sitting there. However, more concerning is an actual worsening of pain on occasion in my chest / upper back. In the past, a couple of consultants have queried if this might be diaphragmatic disease, although (despite me asking) it's never been checked out during surgery with the excuse given that they would not treat it even if it were observed - due to risk factors. To be fair, my surgeries have always been very complex. So, I'm on the look out for a consultant who is a) not dismissive of the possibility of post menopausal endo and b) is experienced re thoracic disease. Before menopause, I remember having conversations with a couple of women who said that Andrew Pickersgill had not dismissed them on the menopause issue - but I'm not sure what his level of experience is re thoracic disease. Have you come across any other names?

[Cailleach in reply to narnian56]

Tbh I haven’t tried! It was about 3 years ago that Edinburgh BSGE declined to see me. I am now 67 and despite being on strong painkillers I have daily pain. I think it is due to adhesions and fibrosis basically sticking my organs together.

I have no recommendations I am afraid. I wonder if you have tried the Facebook group Endometriosis Guidance and Information Resource ? You can ask for recommendations there. To join you have to answer the questions first, I just say that because apparently a lot of people don’t!

Hope you can get some answers. Xx

[narnian56 in reply to Cailleach]

I'm a member of a couple of Endo FB groups but haven't seen that one. I'll give it a go - thanks! I'm sorry that you're still going through all of this at 67. I'm ten years behind you. I was kind of hoping that as time went on things would gradually improve - though I don't think I expected to be completely pain free. However, it's looking a bit less likely recently. I wonder how many of us there are out there, either dealing with active endo, or the aftermath of endo damage, or a combination of both. I read a research paper a few days ago which seemed to be suggesting that there might be a rate of 2-5% of post menopause patients (although they probably can't be called patients as nobody is really treating them!). Of course, as with a lot of endo facts and figures, that might be a complete underestimate. Thanks again x