Menopause

2021, Responses from: Dr Anna Fenton

Does endometriosis make menopause start sooner? 

There is very little data about age at menopause for women with endometriosis. If there has been a need for surgery to remove deposits of endometriosis from the ovaries this can affect ovary function and lead to an earlier menopause. If both ovaries are removed then menopause occurs at the time of surgery.

I am 38 and have just had a hysterectomy for endometriosis (but I have both ovaries). Could I have an earlier menopause? 

Research over the past 30 years, including some from Auckland, has shown that a hysterectomy alone, without removing an ovary is associated with a menopause that is on average 3-4 yrs earlier than average. Part of the blood supply to the ovaries can be affected by the hysterectomy. We see more rapid declines in the AMH level after a hysterectomy and this hormone reflects the ovarian reserve of eggs.

Do endometriosis symptoms persist after menopause? And if they do how can I manage this? 

Sometimes symptoms can persist after menopause because we still see small amounts of estrogen being produced. In overweight or obese women the fat cells make significant amounts of estrogen and that production is not altered by menopause. This  small ongoing exposure to estrogen after menopause can still stimulate endometriosis activity.  This can be managed with pain killers or with some of the same treatments used before menopause.

There may also be pain related to adhesions or scar tissue, things that are not influenced by hormones, that persist after menopause.

In women taking hormone therapy to deal with menopausal  symptoms such as hot flushes there may  be some reactivation of endometriosis.  In some situations, particularly if the endometriosis has affected the bowel,  we would add a progestogen to the estrogen to prevent or minimise this.

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