Endometriosis And Early Menopause and Fibroids: What to Know

Endometriosis, Early Menopause, and Fibroids: What to Know

Pelvic pain, heavy periods, and questions about fertility often bring people to the same crossroads: is it endometriosis, uterine fibroids, or something else—and how does menopause (especially early menopause) fit into the picture? This guide breaks down what these conditions are, how they intersect, and evidence-based options to feel better now and protect long‑term health.

Quick definitions

  • Endometriosis: A condition where tissue similar to the uterine lining grows outside the uterus, often causing pelvic pain, painful periods, and sometimes infertility. It is estrogen-responsive and can persist even after menopause for some people.NIH OWH
  • Uterine fibroids: Noncancerous growths of the uterus that can cause heavy menstrual bleeding, pelvic pressure, pain, and fertility issues depending on size and location. They are also hormone-responsive, typically shrinking after menopause.NIH OWH
  • Early menopause: Menopause between ages 40–45. Premature ovarian insufficiency (POI)—sometimes called premature menopause—occurs before age 40 and involves reduced ovarian function, irregular or absent periods, and low estrogen.NIH OWH

How these conditions can overlap

Endometriosis and fibroids are both driven by estrogen and can cause heavy bleeding and pelvic pain, which makes symptom overlap common. However, they are different diseases with different diagnostic pathways and treatments:

  • Pain profile: Endometriosis often causes cyclic pelvic pain, pain with sex, bowel/bladder symptoms, and pain that can persist outside of menses. Fibroid pain is typically more pressure-like, related to size/location, and linked to heavy bleeding or bulk symptoms (bloating, urinary frequency).
  • Fertility: Endometriosis can affect egg quality, inflammation, and tubal function. Fibroids can impede implantation or distort the uterine cavity (especially submucosal fibroids). Not all fibroids affect fertility.
  • Diagnosis: Fibroids are usually seen on pelvic ultrasound or MRI. Endometriosis can be suspected clinically and with imaging, but definitive diagnosis may require laparoscopy.ACOG

Do endometriosis or fibroids cause early menopause?

On their own, fibroids do not cause early menopause. Endometriosis does not typically cause early menopause either. Most people with either condition will enter natural menopause around the average age (about 51 in the U.S.).

However, certain treatments can lead to temporary or permanent menopause:

  • GnRH agonists/antagonists create a reversible, “medical menopause” to manage symptoms (for both endometriosis and fibroid-related bleeding). Symptoms return when treatment stops.FDA, FDA, FDA, FDA
  • Removal of both ovaries (oophorectomy) causes immediate, permanent menopause. It may be considered for severe endometriosis but has important long-term health trade-offs.
  • Uterine fibroid embolization (UFE) rarely affects ovarian reserve; risk is higher as people near natural menopause.MedlinePlus

What to expect around natural or early menopause

  • Endometriosis: Symptoms often improve after natural menopause as estrogen declines, but disease activity can persist in some. If hormone therapy is used for menopausal symptoms, combined estrogen-progestin regimens are typically preferred to help protect against stimulating residual endometriosis. Decisions should be individualized.ACOG
  • Fibroids: Many fibroids shrink after menopause and bleeding stops. If menopausal hormone therapy (HT) is started, some people may notice renewed bleeding or fibroid growth; careful selection of dose and route, and monitoring, can mitigate this risk.NIH OWH
  • Early menopause/POI: For those with ovarian insufficiency before the usual age, most guidelines recommend systemic hormone therapy (unless contraindicated) until around age 50–51 to protect bone, heart, and brain health.ACOG

Symptoms to discuss with your clinician

  • Heavy bleeding (soaking pads/tampons every 1–2 hours, clots, or bleeding longer than 7 days)
  • Pelvic pain that disrupts activities, pain with sex, bowel movements, or urination
  • Irregular periods, missed periods before age 45, or menopausal symptoms (hot flashes, night sweats) earlier than expected
  • Infertility (12 months of trying under age 35 or 6 months at 35+), recurrent pregnancy loss
  • Signs of anemia (fatigue, dizziness, shortness of breath)

Diagnosis: what might be ordered

  • Pelvic exam to assess uterine size/tenderness.
  • Ultrasound (first-line for fibroids); MRI for detailed mapping or surgical planning.
  • Blood tests for anemia; in suspected POI, FSH and estradiol levels on two occasions several weeks apart.ACOG
  • Diagnostic laparoscopy for confirmation and possible treatment of endometriosis.ACOG

Evidence-based treatments

Endometriosis

  • Pain control: NSAIDs; pelvic floor therapy; multidisciplinary pain care.
  • Hormonal options: Combined hormonal contraceptives, progestins (including levonorgestrel IUD), and GnRH analogs. FDA-approved options include elagolix for pain (Orilissa) and relugolix/estradiol/norethindrone for pain (Myfembree).
  • Surgery: Laparoscopic excision/ablation of endometriosis; evaluation and treatment of adhesions. In select severe cases, hysterectomy with or without oophorectomy may be considered after thorough counseling.

Fibroids

  • Watchful waiting if symptoms are mild and anemia is absent.
  • Medication: NSAIDs for pain; tranexamic acid for heavy bleeding; hormonal contraceptives or levonorgestrel IUD to reduce bleeding. GnRH analogs can shrink fibroids temporarily. FDA-approved oral options for heavy bleeding include elagolix/estradiol/norethindrone (Oriahnn) and relugolix/estradiol/norethindrone (Myfembree).
  • Uterine-sparing procedures: Uterine fibroid embolization (UFE) and MRI-guided focused ultrasound (MRgFUS) can reduce bulk and bleeding without removing the uterus. Discuss fertility plans in advance.
  • Surgery: Myomectomy (fibroid removal) for those seeking future fertility or symptom relief; hysterectomy is definitive for bleeding/bulk when childbearing is complete.

Fertility planning

If pregnancy is a goal, ask for a fertility-focused plan. Endometriosis-related infertility may benefit from surgical treatment, optimized timing, or assisted reproductive technologies. Fibroid impact depends on location: submucosal fibroids and those distorting the uterine cavity are most likely to affect implantation. A reproductive endocrinology consult can personalize options.ACOG

Self-care and long-term health

  • Iron and anemia: Test and treat iron deficiency if bleeding is heavy; consider iron-rich foods and supplements as advised.
  • Bone protection: With early menopause/POI or prolonged low-estrogen therapy, prioritize calcium, vitamin D, resistance exercise, and discuss bone density monitoring.
  • Symptom tracking: Keep a period and pain diary to gauge treatment response.
  • Lifestyle: Regular exercise, healthy weight, sleep, and stress management can help symptom perception and overall health.

When to seek urgent care

Seek prompt care for severe bleeding (soaking through protection hourly), severe or worsening pelvic pain with fever, fainting, or signs of significant anemia.

The bottom line

Endometriosis, fibroids, and the transition into menopause share a hormonal thread but require distinct diagnostic and treatment strategies. Neither condition typically causes early menopause, but some treatments can induce temporary or surgical menopause. Partner with a clinician to match therapy to your symptoms, fertility goals, and long-term health—using options backed by NIH- and FDA-referenced evidence.

Sources and further reading

Related Posts

Back to blog