Forced Menopause Endometriosis and Fibroids: What to Know

September 13, 2025

Forced Menopause, Endometriosis, and Fibroids: What to Know

For many people living with endometriosis or uterine fibroids, pain and heavy bleeding can be life-altering. When symptoms are severe or not responding to standard therapies, clinicians may recommend “forced” (also called induced or medically induced) menopause to temporarily reduce estrogen and improve symptoms. Below is a clear, evidence-informed guide to what forced menopause means, how it’s used, potential benefits and risks, and what to ask your clinician—grounded in guidance from sources such as the NIH, ACOG, and the FDA.

What is forced menopause?

Forced menopause refers to bringing on a menopausal state before the ovaries naturally transition. It can be:

Temporary (medical): Medications lower ovarian estrogen production, creating a reversible, low-estrogen state. These include gonadotropin-releasing hormone (GnRH) agonists and antagonists.
Permanent (surgical): Removal of both ovaries (bilateral oophorectomy) causes immediate menopause.
Treatment-related: Some cancer treatments (chemotherapy/radiation) can induce early menopause.

Because both endometriosis and fibroids are estrogen-sensitive, reducing estrogen can shrink fibroids and quiet endometriosis activity.

Why induce menopause for endometriosis or fibroids?

Endometriosis is driven by estrogen-responsive tissue outside the uterus, which can cause pelvic pain, painful periods, and infertility. Uterine fibroids (leiomyomas) are benign growths in the uterus that can cause heavy bleeding, anemia, pelvic pressure, urinary frequency, and pregnancy complications. Lowering estrogen levels often reduces pain, bleeding, and bulk-related symptoms.

How is forced menopause achieved?

Medication options (reversible)

GnRH antagonists:
- Elagolix is FDA-approved for endometriosis pain (brand: Orilissa). It reduces estrogen quickly and can relieve pain but may decrease bone mineral density (BMD); treatment duration is limited. Non-hormonal contraception is advised during use and for a short period after stopping. (See FDA label: Orilissa.)
- Elagolix + estradiol + norethindrone acetate is FDA-approved to treat heavy menstrual bleeding due to fibroids (brand: Oriahnn). The added low-dose estrogen/progestin (“add-back”) helps protect bone and reduce hot flashes; use is time-limited due to BMD effects. (FDA label: Oriahnn.)
- Relugolix + estradiol + norethindrone acetate is FDA-approved for heavy menstrual bleeding due to fibroids and for endometriosis pain (brand: Myfembree). Add‑back therapy is built in to mitigate bone loss; duration limits apply. (FDA label: Myfembree.)
GnRH agonists:
- Agents such as leuprolide create a temporary low-estrogen state after an initial “flare.” Add-back therapy (low-dose estrogen/progestin) is commonly used to limit hot flashes and bone loss. ACOG notes these can be effective for both endometriosis and fibroid symptom control. (ACOG Endometriosis FAQ; ACOG Fibroids FAQ.)

Medical induction is typically used for months (often 6–24 months depending on the product label) to control symptoms, correct anemia, or as a bridge to surgery. Symptoms may gradually return after stopping if the underlying condition persists.

Surgical options (permanent)

Bilateral oophorectomy removes both ovaries and immediately induces menopause. It is sometimes considered for severe, refractory endometriosis or in the context of hysterectomy for fibroids when childbearing is complete. This approach has lifelong implications for bone, heart, and sexual health and requires careful counseling.
Hysterectomy removes the uterus (curing fibroid-related bleeding); if the ovaries are preserved, you will not enter menopause from the procedure. For endometriosis, hysterectomy may be combined with excision of endometriosis and sometimes oophorectomy, depending on goals and disease extent.

Benefits you might expect

Endometriosis: Many experience reduced pelvic pain, dysmenorrhea, and dyspareunia within weeks of starting GnRH therapy.
Fibroids: Bleeding often decreases within 1–2 cycles; fibroid volume and uterine size may shrink over months, easing pressure symptoms. Medical therapy can help correct iron-deficiency anemia before definitive procedures.

Risks, side effects, and safety

Because these therapies lower estrogen, side effects can resemble menopause:

Hot flashes, night sweats
Vaginal dryness, decreased libido
Mood changes or sleep disruption
Headaches
Bone mineral density loss with prolonged use

To reduce side effects and protect bone, clinicians often recommend add-back therapy (small doses of estrogen plus progestin), which has been shown to maintain symptom control while limiting bone loss for many patients. Product labels include time limits to minimize bone risks. Your clinician may recommend baseline and follow-up bone density (DEXA) scans depending on duration and risk factors.

Important contraceptive note: Pregnancy can still occur on some regimens. The FDA advises non-hormonal contraception during treatment and for a short period after stopping for several products; review the specific label and discuss with your clinician.

Who might consider forced menopause?

Severe endometriosis pain not controlled with NSAIDs or standard hormonal therapies
Heavy menstrual bleeding from fibroids causing anemia or lifestyle disruption
Need for short-term bleeding control before surgery
People seeking to avoid or delay surgery while addressing symptoms

Shared decision-making is essential. Consider your age, fertility goals, symptom severity, other health conditions, and how a temporary versus permanent menopause aligns with your priorities.

Fertility and family planning

Medical suppression is reversible; periods and ovulation typically return after stopping. Forced menopause does not improve egg quality or ovarian reserve. If you hope to conceive, discuss timelines, non-hormonal symptom strategies, and whether surgery (e.g., endometriosis excision or myomectomy) might better support your goals. Some fertility specialists use brief pre‑IVF suppression in select endometriosis cases; this is individualized.

If surgical menopause is being considered and future pregnancy is a possibility, ask about fertility preservation (egg or embryo freezing) before oophorectomy. Cancer patients navigating early menopause can find additional guidance through the NCI (early menopause fact sheet).

After natural menopause: will symptoms go away?

Fibroid-related bleeding typically resolves after natural menopause and fibroids often shrink. Endometriosis activity usually lessens, but lesions can persist and some symptoms may continue. If menopausal hormone therapy (MHT) is needed for vasomotor or bone symptoms, discuss endometriosis history with your clinician; adding a progestin or using combined regimens may reduce the chance of reactivating disease. ACOG provides patient-focused guidance on these nuances (ACOG).

Living well during treatment

Bone health: Adequate calcium and vitamin D intake, weight-bearing and resistance exercise, maintaining a healthy weight, and limiting smoking/alcohol support bone strength. Your clinician may order a DEXA scan if treatment is prolonged or risk is elevated.
Symptom tracking: Keep a diary of pain, bleeding, mood, and side effects to fine-tune therapy.
Iron and anemia: If bleeding has been heavy, monitor iron levels and consider supplementation as advised.
Mental health and sexual wellness: Lubricants/moisturizers, pelvic floor physical therapy, and counseling can help manage dryness, dyspareunia, or mood changes.

Key questions to ask your clinician

Is medical suppression, surgery, or a combination best for my goals?
What symptom changes should I expect and when?
How long can I safely use this medication? Will I need add-back therapy?
How will we protect my bone health and monitor for side effects?
What contraception should I use during treatment?
How does this plan affect my fertility now or later?

Bottom line

Forced menopause can be a powerful, often reversible tool to control endometriosis pain and fibroid-related bleeding. It requires thoughtful planning to balance benefits with side effects, protect bone health, and align with fertility goals. Partner with a clinician experienced in these conditions and rely on evidence-based guidance.