Endometriosis is a painful condition where tissue grows in places it shouldn’t, and it doesn’t automatically go away when women reach menopause. In fact, some women with endometriosis may experience menopause earlier than expected, or their symptoms may continue or get worse after menopause begins. This guide from European menopause experts explains how doctors should care for women with endometriosis during and after menopause, including when surgery might help, which hormone treatments are safest, and how to protect bone health. The research shows that women with endometriosis need special attention during menopause to manage pain, prevent complications, and reduce health risks.

The Quick Take

  • What they studied: How doctors should treat women with endometriosis when they reach menopause, including the best medications, when surgery helps, and what health risks to watch for
  • Who participated: This is a clinical guide based on expert review of existing research, not a study with participants. It combines the latest scientific evidence with recommendations from menopause specialists across Europe
  • Key finding: Women with endometriosis need special care during menopause. Surgery is often the best option for pain relief, and certain hormone treatments are safer than others. Women with endometriosis also have higher risks for heart disease and certain cancers, so regular monitoring is important
  • What it means for you: If you have endometriosis and are approaching or going through menopause, talk to your doctor about whether surgery might help your symptoms. If you use hormone therapy, continuous combined therapy appears safer than other options. Regular check-ups for heart health and cancer screening become even more important

The Research Details

This is a clinical guide created by the European Menopause and Andropause Society (EMAS), which means it’s based on a careful review of all the best available research about endometriosis and menopause. The experts looked at scientific studies, analyzed what works best, and created recommendations that doctors can use when treating patients. This type of guide combines research evidence with expert knowledge to help healthcare providers make the best decisions for their patients.

The guide focuses on practical questions: Should women have surgery? Which hormone treatments are safest? What other health problems should doctors watch for? By reviewing all the available evidence and reaching agreement among experts, the guide provides clear direction for doctors treating women with endometriosis during menopause.

Endometriosis is common, affecting millions of women, and many doctors aren’t sure how to best treat it during menopause. By creating clear, evidence-based guidelines, doctors can provide better care and women can have more informed conversations with their healthcare providers. This approach helps ensure that treatment decisions are based on the best available science rather than guesswork

This guide comes from a respected European organization of menopause specialists and is published in a peer-reviewed medical journal. The recommendations are based on systematic review of existing research. However, because this is a guide rather than a new research study, it doesn’t present original data. The strength of individual recommendations depends on the quality of the underlying research they’re based on

What the Results Show

Surgery appears to be the best option for women with endometriosis who have pain after menopause. Surgery can reduce pain, confirm the diagnosis with certainty, and lower the risk of the condition becoming cancerous. This is important because endometriosis can sometimes continue or even worsen after menopause begins.

Women with endometriosis may experience menopause earlier than average—either naturally or because of surgery to remove the ovaries. This early menopause can cause hot flashes, night sweats, and other uncomfortable symptoms. Hormone therapy can help manage these symptoms and protect bone health, but the type of hormone therapy matters. A specific type called “continuous combined” hormone therapy appears safer for women with endometriosis than other options, because it may reduce the chance of endometriosis coming back or becoming cancerous.

Women with endometriosis face higher risks for several health conditions beyond endometriosis itself, including heart disease, osteoporosis (weak bones), and certain cancers like ovarian, breast, and thyroid cancer. This means regular health check-ups and cancer screenings become especially important.

For women who cannot or choose not to use hormone therapy, other medication options exist for managing hot flashes and night sweats, such as neurokinin-3 receptor antagonists. For bone health, doctors should consider calcium and vitamin D supplements and other bone-protecting medications when appropriate. If endometriosis symptoms return while a woman is using hormone therapy, doctors have several options: adjusting the hormone dose, stopping hormone therapy, or switching to non-hormone treatments. The guide specifically recommends against estrogen-only hormone therapy for women with endometriosis, even if they’ve had a hysterectomy, because it may increase risks. Herbal supplements should be avoided because their safety and effectiveness are unclear, and some may contain estrogen-like compounds that could be harmful

This guide represents current expert consensus on managing endometriosis during menopause. It builds on previous research showing that endometriosis doesn’t automatically resolve at menopause and that women with this condition need specialized care. The emphasis on continuous combined hormone therapy as safer than alternatives reflects growing evidence about how to best protect women with endometriosis while managing menopause symptoms

This is a clinical guide based on expert review rather than a new research study, so it doesn’t present original data from patients. The strength of different recommendations depends on the quality of the underlying research studies. Some areas may have limited research available, which means recommendations are based more on expert opinion than on large clinical trials. Individual women may respond differently to treatments, so recommendations should be personalized with a doctor’s help

The Bottom Line

Women with endometriosis approaching or in menopause should: (1) Discuss with their doctor whether surgery might help their symptoms—this is the preferred first option for pain relief (high confidence); (2) If using hormone therapy, ask about continuous combined therapy, which appears safer than other options (moderate-to-high confidence); (3) Avoid estrogen-only hormone therapy (high confidence); (4) Get regular check-ups for heart health and cancer screening, as risks are elevated (moderate confidence); (5) Ensure adequate calcium and vitamin D intake or supplementation for bone health (high confidence); (6) Avoid herbal supplements unless discussed with their doctor (moderate confidence)

These recommendations are most important for women who have been diagnosed with endometriosis and are approaching menopause (typically ages 40-55) or are already in menopause. Women with a history of endometriosis should discuss these guidelines with their gynecologist or menopause specialist. Women without endometriosis don’t need to follow these specific recommendations, though general menopause care principles still apply. Healthcare providers caring for menopausal women should be aware of these guidelines when treating patients with endometriosis history

Pain relief from surgery typically begins within weeks to a few months. Hormone therapy symptoms (like hot flashes) usually improve within 2-4 weeks of starting treatment. Bone health improvements take longer—usually 6-12 months to see measurable changes. Cancer and heart disease risk reduction is a long-term benefit that develops over years of appropriate management

Want to Apply This Research?

  • Track menopause symptoms daily (hot flashes, night sweats, vaginal dryness) on a 1-10 scale, noting which days you take hormone therapy or other medications. This helps you and your doctor see if treatment is working
  • Set reminders to take calcium and vitamin D supplements daily, schedule regular gynecology and heart health check-ups (at least annually), and keep a symptom diary to discuss with your doctor at appointments
  • Monthly: track symptom severity and medication side effects. Quarterly: review trends with your healthcare provider. Annually: complete cancer screenings and heart health assessments as recommended for your age and risk factors

This guide is for educational purposes and should not replace professional medical advice. Women with endometriosis who are approaching or experiencing menopause should consult with their gynecologist or menopause specialist to discuss personalized treatment options. Treatment decisions should be based on individual health history, symptoms, and risk factors. This information reflects current expert consensus but individual circumstances may vary. Always discuss any new symptoms, medications, or concerns with your healthcare provider before making changes to your treatment plan.