Endometriosis and Menopausal Hormone Therapy

Understanding Endometriosis and Menopause Management

Endometriosis is a condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus, often on the ovaries, fallopian tubes, bowel, bladder, diaphragm, or even the lungs. This can lead to pelvic pain, heavy and painful periods, pain during sex, difficulty with urination or bowel movements, and even infertility. Some women with endometriosis may experience no pain at all but still struggle with infertility.

Diagnosing and Treating Endometriosis

Endometriosis is diagnosed through direct visualization and confirmation of endometrial-like tissue outside the uterus during abdominal surgery. Once identified, an ObGyn will typically remove or destroy as much of the abnormal tissue as possible, which can significantly reduce pain.

When surgery isn’t an option or is insufficient, endometriosis can be managed with hormonal treatments like birth control pills (either combined estrogen-progesterone or progesterone-only). Other medications, such as Lupron, suppress estrogen production, inducing a menopause-like state that may alleviate symptoms but also comes with menopausal side effects like hot flashes, mood changes, and more. Severe cases might require surgical removal of the ovaries and fallopian tubes, which induces surgical menopause.

For women on Lupron who experience menopausal symptoms, a high-dose synthetic progestin can offer relief. Progestins can cause side effects like mood changes, weight gain, or bloating. Lupron is generally prescribed for a maximum of 6-12 months, depending on individual circumstances.

Managing Menopause in Women with Endometriosis

Menopausal hormone therapy (MHT) in women with endometriosis is nuanced, and there are no universally accepted guidelines. There is concern that even after a hysterectomy, residual microscopic endometriosis deposits might reactivate with menopausal estrogen therapy, leading to recurrent pain. For this reason, many women are managed with progesterone alone. If estrogen therapy is desired, it’s often started at lower doses to minimize the risk of symptom recurrence.

One promising option for women with endometriosis is the levonorgestrel IUD (Mirena), which can effectively reduce painful periods and may help manage residual endometrial tissue. Another medication, Duavee (bazedoxifene with conjugated estrogens), is FDA-approved for menopausal symptom relief and has shown promise in reducing endometriotic lesions in animal studies.

Special Considerations

Women with endometriosis may experience early menopause, especially after multiple surgeries. Like any woman undergoing menopause—whether induced by medication, surgery, or naturally—monitoring bone density is essential to prevent osteoporosis. 

Certain cancers, including ovarian and possibly breast and thyroid cancers, are more prevalent in women with endometriosis, while cervical cancer appears to be less common. Additionally, heart attack and stroke risks are higher in this population (heart failure seems to be less common), underscoring the importance of comprehensive health monitoring.

Finding Relief Together

If you have endometriosis and are navigating menopausal symptoms, I’m here to help. There are many options available, including menopausal hormone therapy with progesterone, estrogen, testosterone, and non-hormonal symptom management. If estrogen is recommended, we will start with lower-than-usual doses, carefully balancing it with progesterone to reduce the risk of stimulating residual endometriosis tissue or causing pain. Together, we’ll explore the best options tailored to your unique needs. Managing this condition often requires patience and some trial and error, but with the right approach, relief is well within reach.