Endometriosis affects up to 10 percent of women – possibly more. For some, endometriosis can be a real nightmare, with crippling cramps during periods, heavy period flows, infertility, chronic bloating problems or gastrointestinal , and women begin to dream of sex without pain.
Other women may experience no symptoms at all.
For women who do experience symptoms, there are ways to manage the disease, once it’s been diagnosed – though it takes on average about 7 years to get that diagnosis.
There are also some misunderstandings around endometriosis, including that hysterectomy, pregnancy, or menopause will end the pain. That’s not always the case, and we want women to have the information they need to make good choices for their health and futures.
Endometriosis is when endometrial tissue (similar to what grows in the uterus and is shed during a period) grows where it shouldn’t – inside the abdominal cavity and on the outside of organs such as the uterus, bladder, bowel, and ovaries, among others.
Building up over the month, this tissue responds to the body’s signals to shed during the monthly period – but there’s nowhere for it to go. Trapped, it begins to form adhesions which can bind organs together and pull them out of their normal shapes and places. It’s little wonder that women with “endo” describe the pain of their monthly cramps as debilitating.
Endometriosis can be a bit tricky to diagnose. If cysts have formed, your doc may be able to feel them during a pelvic exam. An abdominal or vaginal ultrasound may be able to detect cysts. Docs might suggest an MRI to identify endometrial growths. Laparoscopy, where a small cut is made in the abdomen so a thin viewing tube can be inserted for the doctor to have a look at internal organs, is considered by many to be the “gold standard” diagnostic tool. With planning, laparoscopy can also be used to surgically treat the disease at the same time.
Periods may be more frequent and heavier during the years leading up to full menopause, meaning women with endometriosis may find symptoms occur more often and are worse during this time. Many women find relief with hormonal birth control pills or an IUD like the Mirena.
For cases that aren’t controlled by birth control, laparoscopic surgery to remove the lesions and excess tissue can help, though there’s a chance the surgery may need to be repeated if new lesions form.
Severe cases may be treated with hysterectomy. However, the long-term health ramifications of early menopause usually mean this is reserved for cases that have no other resolution.
According to Gennev ob/gyn and Director of Health Dr. Rebecca Dunsmoor-Su, endometriosis is estrogen-dependent, so when estrogen is gone, so is the disease. However, this does not mean every woman suddenly finds herself pain-free at menopause. Chronic pelvic pain may continue, and we’ll tackle that very important condition in a future blog.
Whether symptoms abate or not, after menopause, conversations about endometriosis may need to include some additional concerns:
Osteoporosis: According to Harvard Women’s Health Watch, women who have been controlling endo symptoms by taking medications that reduce estrogen (GNrH meds such as Lupron, Synarel, or Zoladex) may be at higher risk of osteoporosis (weakened bones). The publication recommends women ask about osteoporosis medications like bisphosphonate drugs and “be diligent about bone density testing, bone-healthy habits, and follow-up with their clinicians.”
Auto-immune disorders: Endometriosis is not considered an autoimmune disease, but it does appear that women who have endo are at higher risk of such diseases, including lupus, Sjogren’s syndrome, MS, arthritis, IBS, and coeliac disease, as well as allergies and asthma. Women should be vigilant about their health, and if they start to develop new symptoms should consult with a doctor right away.
Cancer: Though some sources might claim a higher cancer risk for women with endometriosis, this hasn’t really proven true, according to the MD Anderson Cancer Center. Harvard Women’s Health Watch says women with endometriosis may face a slightly higher risk of ovarian cancer (though still low), and because the symptoms can mimic those of endo, women should pay attention if symptoms worsen or return. Vigilance beyond normal tests and screenings probably isn’t necessary unless you have other risk factors.
Answer: it might. Says Dr. Rebecca, “HRT may or may not bring symptoms back, as it is lower dose than menstrual hormones. Many women do just fine if they wait a year or so to start.” Hormones that are applied topically may also have less chance of reviving endometriosis.
Every woman needs to have a thorough conversation with a doctor about the pros and cons of taking HRT for menopause symptoms, especially if they have a condition like endometriosis.
Not all pelvic pain is endometriosis, and not every woman with endo experiences symptoms. If you’re having pain during your period, and you’re not sure if it’s just really bad period cramps or something else, talk with a doctor. You are not “overreacting,” you don’t need to just “suck it up.” Pain is your body’s way of communicating a problem, so get help.
Need an doctor's evaluation of your health? A Gennev menopause-certified gynecologist can give you a trusted opinion, determine if medication is right for you, and they can provide prescription support. Book an appointment with a doctor here.
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