Does Endometriosis End After Menopause and Fibroids: What to Know

Does Endometriosis End After Menopause and Fibroids: What to Know

Endometriosis and uterine fibroids are two common gynecologic conditions that often improve as estrogen levels decline with menopause. But improvement does not always mean a complete end to symptoms. Understanding how these conditions behave after menopause helps you make informed choices about symptom monitoring, hormone therapy, and when to seek care.

Quick definitions

  • Endometriosis: Tissue similar to the uterine lining grows outside the uterus, causing inflammation, pain, and sometimes infertility. The National Institutes of Health (NIH) notes that symptoms commonly lessen after menopause, but they can persist or recur in some women, particularly with hormone therapy.
  • Uterine fibroids: Noncancerous tumors of the muscle wall of the uterus. The NIH reports that fibroids usually shrink after menopause as hormone levels fall, yet they may not disappear entirely and can still cause pressure symptoms.

Sources: NIH NICHD on endometriosis; NIH NICHD on uterine fibroids.

Does endometriosis end after menopause?

For many, endometriosis pain eases with menopause because the condition is estrogen responsive. However, endometriosis can persist or even be newly diagnosed after menopause, although this is less common. Residual lesions may remain active due to low levels of estrogen produced outside the ovaries (for example, in adipose tissue), and symptoms may flare with exogenous estrogen from hormone therapy.

The American College of Obstetricians and Gynecologists (ACOG) explains that endometriosis symptoms often improve after menopause but can recur, particularly with certain hormone regimens. Decisions about treatment should be individualized based on symptom burden and overall risks and benefits of therapy.

Source: ACOG Endometriosis FAQ.

Typical postmenopausal symptoms when endometriosis persists

  • Pelvic pain or deep pain with intercourse
  • Bowel or urinary discomfort depending on lesion location
  • Rarely, bleeding associated with lesions on the bowel or urinary tract

Any new or worsening symptoms after menopause warrant evaluation to confirm the cause and rule out other conditions.

What happens to fibroids after menopause?

Fibroids commonly regress after menopause as estrogen and progesterone fall. Heavy menstrual bleeding typically stops, but fibroids can remain and may still cause bulk symptoms, such as pelvic pressure, urinary frequency, constipation, or a feeling of abdominal fullness. According to ACOG, fibroids often shrink after menopause; however, if a fibroid grows or new bleeding begins after menopause, a prompt workup is important to exclude other causes.

Sources: ACOG Uterine Fibroids FAQ; NIH NICHD Fibroids overview.

Red flags with fibroids after menopause

  • New or persistent vaginal bleeding after menopause
  • Rapidly enlarging pelvic mass
  • Unexplained pelvic pain or pressure that is worsening

While uterine sarcoma is rare, growth of a presumed fibroid after menopause requires evaluation. Postmenopausal bleeding should always be assessed.

Why symptoms can persist after menopause

  • Residual disease: Endometriosis lesions or fibroids may not completely regress and can remain symptomatic.
  • Hormone therapy (HT): Estrogen therapy can stimulate residual endometriosis or fibroid tissue. ACOG notes that HT may relieve menopausal symptoms but can trigger recurrence of endometriosis symptoms or enlargement of fibroids.
  • Peripheral estrogen: Small amounts of estrogen are still produced in adipose tissue, which may sustain some activity of hormone-responsive lesions.
  • Other medications: Agents with estrogenic activity, such as tamoxifen, can sometimes stimulate the uterus or fibroids. Discuss medication history with your clinician.

How are postmenopausal symptoms evaluated?

Your clinician will tailor testing to your symptoms, which may include:

  • Pelvic exam to assess tenderness or palpable masses
  • Transvaginal ultrasound to visualize the uterus, ovaries, fibroids, and endometrial thickness
  • MRI in complex cases or to map deep disease
  • Endometrial sampling if there is postmenopausal bleeding, to rule out precancer or cancer
  • Diagnostic laparoscopy in selected cases when imaging is inconclusive and symptoms persist

For bleeding after menopause, ACOG recommends prompt evaluation to identify causes and exclude endometrial cancer or other conditions.

Source: ACOG on abnormal uterine bleeding.

Treatment options after menopause

Endometriosis

  • Expectant management: If symptoms are mild and not progressive, monitoring may be reasonable.
  • Pain management: Intermittent NSAIDs or other pain strategies as appropriate and safe for your health profile.
  • Hormone therapy adjustments: If menopausal hormone therapy is needed for vasomotor or bone symptoms, discuss the lowest effective dose and consider combined estrogen-progestin rather than estrogen alone to reduce stimulation of residual endometriosis. Individualize based on your history and risk factors.
  • Surgery: In selected cases with persistent pain or suspicious masses, minimally invasive surgery to remove lesions or scar tissue can be considered. Decisions depend on overall health, imaging findings, and goals.

Many medications approved by the US Food and Drug Administration (FDA) for endometriosis pain, such as oral GnRH antagonists, are indicated for premenopausal women. Examples include elagolix for endometriosis pain and combination therapies for related indications. These are generally not used after menopause.

Sources: FDA on elagolix for endometriosis pain.

Fibroids

  • Watchful waiting: If fibroids are stable and not causing significant symptoms, observation is often appropriate after menopause.
  • Targeted procedures for bulk symptoms: In persistent cases, options may include uterine artery embolization or, less commonly after menopause, surgical removal. Choice depends on symptom severity, anatomy, and overall health.
  • Medication notes: Several FDA-approved medical options for heavy menstrual bleeding due to fibroids target premenopausal women, such as elagolix with add-back therapy or other combination therapies. Because bleeding should cease after menopause, new bleeding requires evaluation rather than routine use of these medicines.

Sources: FDA on therapies for fibroid-related bleeding; ACOG Fibroids FAQ.

Hormone therapy after menopause if you have a history of endometriosis or fibroids

HT is not automatically off the table, but it requires shared decision-making:

  • Discuss benefits for hot flashes, sleep, and bone health versus the possibility of symptom recurrence.
  • Consider combined estrogen-progestin therapy if you have a history of endometriosis, even after hysterectomy, to lower the chance of stimulating residual disease. Evidence is limited; decisions are individualized.
  • With fibroids, some women notice small changes in size on HT; clinically significant growth after menopause is less common but should be monitored.
  • Use the lowest effective dose for the shortest duration that meets your goals.

Sources: ACOG Endometriosis FAQ; ACOG Fibroids FAQ.

When to seek care

  • Any vaginal bleeding after menopause
  • New or worsening pelvic pain, pressure, or a growing abdominal mass
  • Urinary or bowel changes that persist
  • Unexplained weight loss, fever, or fatigue

These warrant prompt evaluation to determine the cause and to rule out conditions that require treatment.

Bottom line

Endometriosis symptoms often improve after menopause, but they do not always disappear. Fibroids usually shrink but can remain and occasionally cause pressure symptoms. Hormone therapy can help menopausal symptoms but may stimulate residual disease, so plans should be individualized and monitored. If you experience bleeding or new pelvic symptoms after menopause, seek medical evaluation.

This article is for general information and does not replace personalized medical advice. Discuss your symptoms and treatment options with a qualified clinician.

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