Managing Endometriosis and Fibroids Through Menopause


As women enter the phase of life known as menopause,  their bodies undergo profound hormonal changes. While this transition signifies the end of the reproductive years, it can also bring relief from certain gynecological conditions. In this blog post, we will explore how menopause can affect symptoms related to endometriosis and fibroids.

Endometriosis and Menopause

Endometriosis, a condition characterized by the presence of endometrial tissue outside the uterus, is known to thrive on excess estrogen. While it’s essential to clarify that estrogen does not cause endometriosis, its excess availability can exacerbate the condition. For many women, endometriosis becomes evident during adolescence with progressively worsening painful menstrual periods, and for some women that can additionally progress to pelvic pain outside of menstruation. Fortunately, for some, symptoms improve during pregnancy or while taking birth control pills or other hormonal contraception [ IUD, Depot provera, Nexplanon, Nuva ring, Patch]  due to a temporary cessation of menstrual cycles and the cyclical nature of estrogen.

However, as women enter the years after their last menstrual cycle, called postmenopause, they not only experience a cessation of their menstrual cycles but also their estrogen levels. This leads to that most women will find relief from endometriosis-related pelvic pain as their estrogen levels stabilize at a very low level. Particularly if their pain was primarily associated with menstrual cycles, it tends to subside.

Nevertheless, there are exceptions. Women who experienced non-menstrual -pelvic pain may take longer to find relief in postmenopause or may not experience complete resolution. Several factors could contribute to persistent pain:

1. Scar Tissue: Long-standing endometriosis can lead to the formation of scar tissue in the pelvis, that can cause pain symptoms independently from estrogen stimulation

2. Pelvic Surgery: Previous pelvic surgeries can also result in scar tissue, potentially causing ongoing discomfort.

3. Pelvic Floor Musculature: Chronic pelvic pain can lead to tightness in the pelvic floor muscles, which can become a source of pain. Pelvic floor physical therapy may be beneficial in such cases.

4. Vaginal Changes: Vaginal estrogen preparations might help relieve symptoms by addressing the tightening of the vaginal mucosa due to low estrogen levels in menopause, which can worsen symptoms related to intercourse and urinary frequency.

If you’re experiencing persistent pelvic pain during menopause, it’s crucial to consult your gynecologist for a comprehensive assessment to identify the source of your discomfort. Together, you can explore suitable treatment options tailored to your specific needs.

Fibroids and Menopause

Fibroids are considered benign tumors in the uterine wall composed of dense muscle fibers. They are very prevalent in women approaching menopause. These growths typically start developing in the early 30s, with peak growth occurring during perimenopause, the years leading up to menopause. Fibroids are known to thrive on excess estrogen, which is often present during the 8-10 years leading up to menopause. This time is called perimenopause and is known for its fluctuating hormone levels, and is for that reason often also the most symptomatic time for many women. 

Large fibroids can grow to be 10 cm or larger, and multiple fibroids can cause the uterus to reach a size equivalent to a 5 to 6-month pregnancy. Symptoms of fibroids can include heavy menstrual bleeding, menstrual cramping, pelvic pressure, and discomfort.

The good news is that with the onset of menopause, estrogen levels decrease significantly, leading to positive changes in the behavior of fibroids:

1. Shrinking Fibroids: Fibroids usually start to shrink in postmenopause because they require high estrogen levels to thrive.

2. Relief from Menstrual Issues: For women whose primary concern was heavy menstrual bleeding or cramping, menopause often brings relief as menstrual cycles cease.

However, it’s important to note that while fibroids tend to shrink in postmenopause, they rarely disappear entirely unless they were initially very small. For women with a large fibroid uterus, the reduction in size may not provide sufficient relief, especially if the fibroids were pressing on the bladder, causing urinary frequency, or affecting bowel movements and pelvic pressure.

Therefore, women who experience significant symptoms due to large fibroids should consider seeking treatment when necessary rather than waiting for menopause to provide complete relief.

In conclusion

Menopause, with its declining estrogen levels, can bring relief from endometriosis-related pelvic pain and fibroid-related menstrual issues. However, it’s essential to remember that individual experiences may vary, and all symptoms should be discussed with and evaluated by your gynecologist. Whether managing endometriosis or fibroids, understanding the changes that occur during menopause can empower women to make informed decisions about their health and well-being during this life stage.

About Me

Dr. Christina Enzmann is a gynecologist and a certified member of the North American Menopause Society.

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