Menopause and Endometriosis

Symptoms can persist for some people after menopause and should not be dismissed. Menopause may change endometriosis symptoms, especially when periods stop and hormone patterns change. But menopause does not mean endometriosis symptoms are impossible, unimportant or “all in the past”. Some people improve after menopause. Others continue to have pelvic pain, bowel or bladder symptoms, pain with sex, fatigue or scar-related pain. New symptoms after menopause should always be assessed.

After menopause

Endometriosis symptoms may continue after menopause for some people, especially if there has been:

  • previous severe or deep endometriosis
  • bowel, bladder, ureter or extra-pelvic involvement
  • endometriomas
  • repeated surgery
  • adhesions or scar tissue
  • pelvic floor pain
  • nerve-like pain
  • hormone therapy use
  • persistent pain before menopause

Symptoms after menopause may still be linked with endometriosis, but other causes also need to be considered.

Symptoms that need review

Ask for medical review if you have:

  • new pelvic or abdominal pain
  • pain that is worsening
  • pain during or after sex
  • new bowel changes
  • new bladder symptoms
  • blood in wee or stool
  • bloating that is persistent or worsening
  • unexplained weight loss
  • new fatigue that feels unusual
  • scar pain or swelling
  • symptoms that return after starting HRT

Do not assume new symptoms are endometriosis. After menopause, it is important to rule out other conditions too.

Bleeding after menopause

Bleeding after menopause should always be checked by a GP, even if it is light spotting, brown discharge, pink discharge or only happens once. There can be several causes, and many are not serious, but bleeding after menopause needs assessment because it can sometimes be a sign of womb, cervical or ovarian cancer.

HRT discussions

Hormone replacement therapy, often called HRT, may be considered for menopause symptoms such as hot flushes, night sweats, sleep disruption, vaginal dryness, mood changes or bone health concerns. If you have a history of endometriosis, tell the clinician before starting or changing HRT. Ask how your endometriosis history affects:

  • the type of HRT suggested
  • whether combined hormone therapy is needed
  • benefits and risks
  • symptom monitoring
  • what to do if pelvic pain or bleeding returns
  • whether specialist advice is needed

HRT is not automatically wrong for everyone with endometriosis, but it should be discussed carefully and individually.

Surgical menopause

Some people enter menopause early because both ovaries are removed during surgery. This is sometimes called surgical menopause. If ovary removal is discussed, ask about:

  • why it is being recommended
  • whether all visible endometriosis will be removed at the same time
  • possible benefits and risks
  • effects on menopause symptoms
  • bone, heart and sexual health
  • HRT options
  • endometriosis recurrence risk
  • follow-up care

This decision can have long-term effects and should not feel rushed.

Questions to ask

You may want to ask:

  • Could endometriosis still be relevant after menopause?
  • What else could be causing these symptoms?
  • How does HRT affect my situation?
  • What symptoms need investigation?
  • Should I have a pelvic examination, ultrasound or other tests?
  • Do my previous surgery notes matter?
  • Should I be referred to gynaecology or an endometriosis specialist?
  • What should I do if pain or bleeding returns after starting HRT?

Prepare before you speak with a healthcare professional

Use our Prepare for Appointment Tool to organise your symptoms, questions, surgery history, previous treatments, HRT use and priorities before your appointment. Try to record when symptoms started, whether you have had any bleeding, whether symptoms changed after HRT, previous endometriosis locations, previous operations, and how symptoms affect daily life. You do not need a perfect diary. A clear summary can help the conversation feel more focused.

Finding the right type of care

Use the Endometriosis Care Directory to explore endometriosis-related care providers, including gynaecologists, menopause clinicians, pain specialists, pelvic physiotherapists and specialist endometriosis services. The directory is for research and information only. It is not a recommendation, referral service, ranking or medical advice. Always check details directly with the provider and speak with an appropriate healthcare professional before making decisions about your care.

Final reminder

Menopause may change endometriosis symptoms, but it does not make symptoms impossible. You deserve care that takes postmenopausal pain, bleeding, bowel or bladder changes, HRT questions and previous endometriosis history seriously. This resource is here to support your understanding, not replace medical advice from a qualified healthcare professional.