Does Endometriosis Go Away After Menopause? Here’s the Truth

There’s a common belief that menopause “cures” endometriosis. No more periods = no more pain, right?

Unfortunately, that’s not always the case. While some women do experience symptom relief after menopause, others continue to struggle with endometriosis after menopause-related pain. In some cases, endo symptoms can even get worse during the menopausal transition.

In this article, we’ll unpack what really happens to endometriosis as hormone levels shift, what to consider if you’re exploring HRT after menopause, and why menopause and endometriosis pain may still be connected, even long after your last period.

Does Endometriosis Go Away After Menopause? Why This Question Matters

Many doctors still believe that endometriosis goes away after menopause, or that a hysterectomy solves the problem entirely. But if you’ve lived with this condition, you know it’s more complex.

Here’s what we now understand about the connection between menopause and endometriosis:

• Endometriosis is an estrogen-dependent inflammatory disease¹, but it isn’t solely dependent on ovarian estrogen, in fact, these lesions may produce their own hormones.
• Endo lesions can persist (and remain active)² even after hormone levels drop. 
• Endo pain (and other symptoms like “endo belly” bloating) can continue post-menopause, especially when endometriosis affects the bladder, bowel, or other organs.

So if you’re still asking, “Can you get endometriosis after menopause?”—the answer is yes. It may be less common, but it’s very possible and very real for some women.

A large retrospective study³ of over 42,000 women with confirmed endometriosis found that while the majority were premenopausal, 2.55% had endometriosis after menopause. Other studies have found that up to 4% of women⁴ with endo are in their menopausal or post-menopausal years.

These findings confirm that although less common, postmenopausal endometriosis does occur and should not be overlooked. According to researchers involved in the study, “Due to the relatively high prevalence of the condition in patients aged over 40, physicians should consider endometriosis in cases of unclear pelvic pain in this age group.”

For even more support on this topic, listen to my full podcast episodes on endometriosis— including Endometriosis Treatment: A Doctor’s Guide to Surgery Prep and Recovery and How to Tell If You Have Endometriosis—and download the Endo Flare Toolkit for natural remedies and advice to help manage your symptoms.

What Happens to Endometriosis at Menopause?

Endometriosis is defined by tissue similar, but distinct in its own characteristics, to the uterine lining growing outside the uterus. These lesions are not only influenced by systemic estrogen (estrogen circulating within the body, mostly from the ovaries); they can also produce their own estrogen through an enzyme called aromatase. 

Additionally, endo after menopause can be fueled by other sources of estrogen, including from body fat, hormone replacement therapy, and even certain foods (to a lesser degree).

Here’s more about how endo can occur during and after menopause:

• Postmenopausal endometriosis has a more complex origin than premenopausal cases. Even after the ovaries stop producing estrogen, estrone, made in fat and skin tissue⁵, can still fuel endometriosis growth. 

• One theory suggests that once estrogen passes a certain threshold, it can reactivate dormant endometrial tissue. 

• Yet another issue is that during perimenopause, estrogen begins to fluctuate wildly while progesterone declines steadily. This creates a scenario of unopposed estrogen, which can stimulate endometriosis lesion growth and inflammation.

• Additionally, external sources of estrogen like HRT (hormone replacement therapy) and phytoestrogens, may also raise estrogen levels enough to sustain or trigger postmenopausal endometriosis symptoms.

• All of this means that even after menopause, local estrogen production can continue at the lesion site, especially if inflammation and aromatase activity remain high.

In short, menopause doesn’t always eliminate the root of endometriosis symptoms. And for women with deep infiltrating endo or adhesions, symptoms can remain or return during and after menopause.

Why Symptoms Can Persist—or Even Worsen—After Menopause

If you’ve reached menopause but are still experiencing endometriosis flare-ups along with back or pelvic pain and other symptoms, you’re not imagining things. Because there are no menstrual cycles to track during and after menopause, it can be harder to diagnose endometriosis, and symptoms may mimic other gynecological issues; however this issue is still one to discuss with your provider.

Postmenopausal endometriosis can cause symptoms⁶ including:

• Pelvic pain
• Painful intercourse
• Bowel or urinary symptoms (bowel endometriosis after menopause), which can include lower abdominal pain around the rectum or lower back, pain during bowel movements, constipation or diarrhea, bloating, gas, and rectal bleeding
• Nausea or appetite changes
• Pain when sitting (in advanced or deep lesions)
• Abnormal bleeding

As mentioned above, several mechanisms can keep endo symptoms active even after your period stops due to menopause:

• Loss of progesterone: Progesterone has calming, anti-inflammatory effects. When it disappears, so does its protective influence.

• Adhesions and scar tissue: These don’t dissolve with menopause. They can develop in several different parts of the body, like the bladder and bowels, and cause chronic pelvic pain, bowel dysfunction, or bladder symptoms. 

• Deep infiltrating lesions: Endometriosis that affects organs like the bowel or bladder may continue to cause pain or dysfunction long after estrogen levels drop.

Hysterectomy and Endometriosis: Why It’s Not a Cure

Removing the uterus doesn’t always mean removing the disease. Hysterectomy addresses uterine pain, not endometrial lesions that exist on other organs, which is what endometriosis is by definition. Even after hysterectomy, if endometriosis lesions remain, they may still respond to any circulating or local estrogen.

Here's another potential issue: many women are prescribed estrogen-only HRT after hysterectomy, but this can reactivate endometriosis⁷ if unopposed by progesterone.

If you’ve had your uterus removed and are considering hormones, estrogen-only therapy is usually not appropriate if you’ve had endo. In fact, there is evidence that estrogen-only may contribute to the development of ovarian cancer⁸ if endometriomas (ovarian endometriosis) is present, but that the risk is mitigated by including progesterone. 

It’s critical to work with a practitioner who understands this distinction, or else there's a risk of worsening your endo symptoms.

Hormone Replacement Therapy (HRT) After Menopause: What You Need to Know if You Have Endometriosis

So what about HRT after menopause? Should you avoid it completely if you’ve had endometriosis? Not necessarily. But it must be done with care.

HRT menopause benefits can include improved sleep, mood, libido, and bone health, and those benefits apply even if you’ve had endo.

But endometriosis HRT menopause protocols⁹ should always include bioidentical progesterone, even if you’ve had a hysterectomy. Progesterone helps counterbalance estrogen, reduce inflammation, and may even suppress lesion activity.

Some advanced practitioners may explore aromatase inhibitors in severe cases to reduce local estrogen production. But this approach must be carefully monitored.

When Endometriosis Involves More Than Pain: Organ Involvement After Menopause

Some women continue to experience endometriosis symptoms not because of hormones, but because of structural damage from prior endometriosis. Here are some examples of why symptoms can persist even after painful periods stop:

• Bowel endometriosis after menopause can still cause bloating, pain with digestion, constipation, or even obstruction if strictures are present.

• Bladder involvement may lead to urgency, frequency, or pelvic pain.

• Diaphragmatic or thoracic endometriosis, though rare, may cause upper abdominal or chest pain and breathing issues.

• Adhesions can restrict organ movement, create painful pulling sensations, and contribute to gastrointestinal or urinary symptoms.

Related: 
Endometriosis and IBS: Symptom Connection and Solutions
Connection Between Gut Health, Menopause, and Perimenopause

Can Endometriosis Cause Hot Flashes?

Hot flashes are primarily driven by hormone withdrawal (especially estrogen), not by endometriosis itself. However:

• The inflammation from endometriosis can intensify vasomotor symptoms, making hot flashes and night sweats feel more severe.

• Certain HRT regimens can worsen endo symptoms¹⁰ if not appropriately balanced with progesterone in women with a history of endo.

Related: 10 Odd Symptoms of Menopause

How to Manage Endometriosis Naturally, Even After Menopause

While we don’t have a universal cure yet for endometriosis, many women benefit from ongoing support to help calm inflammation, support detoxification, and rebalance their hormones. This is where natural remedies for endometriosis (which you can read much more about here) come into play, which include a healthy diet, exercise, stress management, and so on.

Even though endometriosis is often treated surgically or hormonally, many women benefit from a whole-body approach. These natural tools aren’t about “curing” endometriosis, but rather creating the internal environment where your body can feel safer, calmer, and more resilient, especially postmenopause. They can also help to lower the risk of obesity, which is a leading risk factor for endo during menopause.

Related: Tips to Help With Menopause Weight Loss and 6+ Ways to Eliminate Menopause Belly Fat

Here are a few natural strategies that can often help manage endo:

1. Continue Anti-Inflammatory Nutrition

Chronic inflammation is a core driver of endometriosis pain and lesion activity. You can help ease this internal fire with the right nutrients on your plate.

• Focus on a fiber-rich, antioxidant-loaded diet: This can help reduce inflammation and support gut health.

• Include omega-3 fatty acids: Omega-3s, from foods like wild-caught fish, flax seeds, chia seeds, and walnuts, as well as supplements, can help lower prostaglandins that fuel endo-related pain. Look for a 3rd party tested, high quality omega-3 supplement, like my Omega Plus. 

• Load up on cruciferous vegetables: Veggies like broccoli, cauliflower, and Brussels sprouts help support estrogen detox and have anti-inflammatory effects.

• Consume more antioxidants: Add colorful berries and leafy greens for their polyphenols and antioxidants, as these can help reduce oxidative stress that can worsen endo symptoms. Consider rotating your anti-inflammatory foods each week to maximize diversity and nutrient intake.

• Avoid inflammatory triggers: Limit or avoid ultra-processed foods, refined sugar, alcohol, and industrial seed oils (like soybean or canola oil).

2. Support Estrogen Metabolism

Excess or poorly metabolized estrogen, whether from your own body or environmental xenoestrogens, can feed endometriosis growth. Supporting proper estrogen breakdown and elimination is essential at every stage, including postmenopause.

• DIM (Diindolylmethane): A compound from cruciferous veggies that supports the conversion of estrogen into its “cleaner,” less inflammatory forms.

• Calcium-D-glucarate: Supports liver detox and helps prevent reabsorption of estrogen in the gut (especially helpful for those with gut imbalances).

• Sulforaphane: Found in broccoli sprouts and cruciferous vegetables, this powerful antioxidant activates detox enzymes and supports phase 2 liver detox pathways.

You’ll find these key ingredients, along with important hormone nutrients like selenium and vitamin B6 in The Dr. Brighten Essentials Balance Women’s Hormone Support formula. 

Work with a practitioner to tailor supplement dosing to your unique needs, especially if you’re also on hormone replacement therapy.

3. Focus on Nervous System Regulation to Calm Pain Signaling

Endometriosis is more than just a hormone issue; it’s also a nervous system issue, and chronic pain can upregulate your brain’s pain receptors and increase sensitivity, even after the hormonal drivers are reduced. 

That’s why nervous system regulation is non-negotiable in long-term endo management, not to mention it has many benefits for managing menopause symptoms, too. Healing happens when your body feels safe, and safety starts in the nervous system! Try these natural remedies to support nervous system function:

• Breathwork: Simple diaphragmatic breathing and box breathing can activate the parasympathetic nervous system and lower cortisol, helping reduce pain sensitivity.

• Somatic therapy: Gentle body-based therapies like TRE (Tension & Trauma Release Exercises), somatic experiencing, or craniosacral therapy can help process stored trauma and calm a hyperactive pain loop.

• Gentle movement: Activities like yin yoga, walking, tai chi, and stretching can increase circulation, support lymphatic flow, and ease tension in the pelvic area.

• Vagal tone practices: Singing, humming, gargling, or cold exposure can stimulate the vagus nerve, your body’s built-in anti-inflammatory pathway. Here’s more on how to stimulate the vagus nerve.

4. Consider Bioidentical Progesterone (If Working With a Provider)

Progesterone isn’t just for cycling women. Even postmenopausal, bioidentical progesterone can offer benefits for women with a history of endometriosis, particularly if symptoms persist or if you’re using estrogen therapy.

Progesterone helps oppose estrogen, reducing inflammation and slowing down endometrial lesion activity. It also supports GABA receptors in the brain, helping improve sleep, mood, and anxiety, all of which can be disrupted in women with endometriosis.

• Bioidentical forms (like micronized progesterone or compounded formulations) are often better tolerated and may offer additional neuroprotective and metabolic benefits.

• If you're on HRT after menopause, be cautious with estrogen-only formulations—progesterone should always be part of the plan if you have a history of endo.

• Always work with a knowledgeable provider to personalize your hormone plan and monitor for any endo-related symptom recurrence.

Here’s more about how progesterone supports GABA.

When to See a Specialist

If you’re postmenopausal but still dealing with pelvic pain, digestive issues, or urinary symptoms—and you’ve had endo in the past—it’s time to advocate for yourself.

Ask your provider:

• Could endometriosis still be active?
• Am I on the right type of HRT for my history?
• Do I need imaging (MRI or gel contrast ultrasound) to evaluate lesions or adhesions?

Make sure your practitioner understands both endometriosis and hormone therapy, and don’t be afraid to seek a second opinion if needed.

Key Takeaways: Does endometriosis go away after menopause? 

So, can you still have endometriosis after menopause, or does it automatically go away?

• Endo symptoms can persist or worsen due to local estrogen production, adhesions, and organ involvement. In other words, yes, you can get endometriosis after menopause, especially if lesions were never fully excised or if unopposed estrogen therapy is used.

• Menopause and endometriosis pain are still closely connected and deserve serious attention.

• HRT menopause benefits are still accessible for women with a history of endo, but must include progesterone to prevent symptom recurrence.

• There are natural remedies to cure endometriosis symptoms, especially when it comes to inflammation and hormone support.

Want more support? Listen to my endometriosis podcast episodes and download the free Endo Flare Toolkit, an evidence-based guide packed with practical tools to help you reduce endometriosis pain, calm inflammation, and regain control over your life.

• Endometriosis Treatment: A Doctor’s Guide to Surgery Prep and Recovery 
• How to Tell If You Have Endometriosis
• Endo Flare Toolkit

References

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