Do Endometriosis Lesions Disappear After Menopause?

Not necessarily.

Many people are told that endometriosis “ends” with menopause. While symptoms often improve as ovarian estrogen declines, this is not always true. Lesions can remain present—and sometimes symptomatic—even after menopause.

Endometriosis is estrogen-responsive, meaning estrogen stimulates lesion growth. This explains why symptoms often fluctuate during the menstrual cycle during reproductive years.

However, lesions are not entirely dependent on ovarian estrogen alone. They may also persist due to:

  • Chronic inflammation

  • Immune dysregulation

  • Local estrogen production within lesions

All of these factors can contribute to lesion persistence.

Understanding Endometriosis Beyond Menopause

After menopause, the ovaries stop producing significant amounts of estrogen. However, estrogen does not completely disappear. There are several non-ovarian sources:

1. Peripheral Aromatization in Fat Tissue

After menopause, estrogen is primarily produced through peripheral aromatization — a process in which fat tissue converts androgen hormones into estrogen via the aromatase enzyme.

This becomes the main source of circulating estrogen after menopause.

2. Higher Body Fat Levels

Because adipose (fat) tissue is responsible for this conversion, individuals with higher body fat may produce greater amounts of estrogen through this pathway.

This can result in slightly higher circulating estrogen levels even after menopause, potentially influencing residual lesion activity.

3. Local Estrogen Production Inside Lesions

Endometriosis lesions can produce their own estrogen locally through aromatase enzyme activity, creating a self-sustaining microenvironment.

4. Hormone Replacement Therapy (HRT)

Hormone therapy is often prescribed to relieve menopausal symptoms such as hot flushes. It may contain:

  • Estrogen alone

  • Estrogen combined with progesterone

Because HRT provides an external source of estrogen, it could potentially stimulate residual endometriosis.

Decisions about HRT should always be individualized and carefully discussed with a clinician.

How Common Is Postmenopausal Endometriosis?

One study estimates that approximately 2.5% of endometriosis cases are diagnosed in postmenopausal women (study age range: 55–95 years).

Although this is a relatively small proportion, it demonstrates that postmenopausal disease is possible. Diagnostic delay may contribute to this percentage, as symptoms may be overlooked in this age group.

Most postmenopausal lesions are found in the ovaries.

Endometriosis should still be considered in cases of:

  • Unexplained pelvic pain

  • Pelvic masses

  • New or persistent symptoms after menopause

This is true even in the absence of a prior diagnosis. Careful clinical evaluation is recommended to determine the underlying cause.

Perimenopause: Can Symptoms Worsen During the Transition?

Perimenopause — the hormonal transition leading to menopause — can be unpredictable.

Estrogen levels may fluctuate widely for years before permanently declining. Clinical reviews suggest that symptoms can temporarily worsen during this time before stabilizing after menopause.

However, experiences vary significantly between individuals.

Medically Induced Menopause

In addition to natural menopause, some patients experience treatment-induced menopause.

Medications such as:

  • Goserelin (Zoladex)

  • Other GnRH agonists

are sometimes prescribed to treat endometriosis.

These medications temporarily suppress ovarian estrogen production to reduce lesion growth and relieve symptoms. In doing so, they induce a reversible state often referred to as “medical menopause.”

Younger patients taking these medications may experience symptoms similar to natural menopause, including:

  • Hot flashes

  • Mood changes

  • Vaginal dryness

This transition can present both physical and emotional challenges. Individualized counseling can help make this experience more manageable.

What Can Help?

Management of endometriosis after menopause is highly individualized. Symptoms can fluctuate significantly and should always be evaluated on a case-by-case basis with a clinician.

The Role of Clinical Evaluation

  • Discuss new symptoms or changes in pain patterns

  • Carefully assess any new pelvic mass or vaginal bleeding after menopause

  • Counsel on safe HRT use if appropriate, balancing health benefits and risks

Key Takeaways

  • Many patients experience symptom relief after menopause due to reduced ovarian estrogen, but endometriosis can persist.

  • Endometriotic tissue can express aromatase, enabling local estrogen production.

  • Chronic inflammation and immune dysregulation may help sustain lesion survival independently of menstrual cycles.

  • Postmenopausal endometriosis, although uncommon, is clinically recognized.

💛 You Are Not Alone

If you are navigating endometriosis during perimenopause, after menopause, or through treatment-induced menopause, support is available.

👉 Join the Endometriosis Post-Menopause Support Group HERE.

References
  1. Haas D, Chvatal R, Reichert B, Renner S, Shebl O, Binder H, et al. Endometriosis: a premenopausal disease? Age pattern in 42,079 patients with endometriosis. Arch Gynecol Obstet. 2012;286(3):667–670.
  2. Bulun SE. Endometriosis. N Engl J Med. 2009;360(3):268–279.
  3. Cleveland Clinic. Hormone therapy for menopause symptoms. Cleveland (OH): Cleveland Clinic; [cited 2026 Feb 20]. Available from: https://my.clevelandclinic.org/health/treatments/15245-hormone-therapy-for-menopause-symptoms
  4. Secosan C, Balulescu L, Brasoveanu S, Balint O, Pirtea P, Dorin G, et al. Endometriosis in menopause—renewed attention on a controversial disease. Diagnostics (Basel). 2020;10(3):134. doi:10.3390/diagnostics10030134.
  5. Gemmell LC, Webster KE, Kirtley S, Vincent K, Zondervan KT, Becker CM. The management of menopause in women with a history of endometriosis: a systematic review. Hum Reprod Update. 2017;23(4):481–500.
  6. Endometriosis UK. Endometriosis and menopause. London: Endometriosis UK; [cited 2026 Feb 20]. Available from: https://www.endometriosis-uk.org/jos-hot-topics-endometriosis-and-menopause
  7. Seckin T. What to expect post-menopause when it comes to endometriosis. New York: Seckin Endometriosis Center; [cited 2026 Feb 20]. Available from: https://drseckin.com/what-to-expect-post-menopause-when-it-comes-to-endometriosis/
  8. National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management (NG73). London: NICE; updated 2022.
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