Endometriosis After Menopause: Symptoms and Risk

Medically reviewed by Danielle Grimm, MPH, MSN, CNP, WHNP-BC, MSCP · Written by Lauren Sherman, M.S. · June 4, 2026

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Key Takeaways

While many people expect menopause to bring relief from endometriosis, the condition can actually continue, return, or in rare cases even appear for the first time after menopause.

You might assume that one benefit of menopause is relief from pelvic pain from endometriosis. For many women, endometriosis symptoms do improve after menopause, but endometriosis can still happen after menopause.

Endometriosis symptoms may continue after menopause, come back after years of relief, or, in rare cases, start for the first time after menopause. Here’s what you need to know about endometriosis after menopause.

What Is Endometriosis?

Endometriosis is a long-term condition in which tissue similar to the lining of the uterus grows outside the uterus. This tissue can cause:

Inflammation
Adhesions (bands of scarlike tissue that can cause organs to stick together)
Pain

Common places for endometriosis growths include the:

Ovaries
Fallopian tubes
Tissue lining the pelvis
Space behind the uterus

Less commonly, endometriosis may affect the bladder, bowel, diaphragm (the muscle that helps you breathe), or other areas.

Endometriosis affects an estimated 10 percent of women of reproductive age worldwide. It’s most often diagnosed in women in their 20s and 30s.

Endometriosis is often linked to estrogen, a hormone that can help endometriosis tissue grow. After menopause, the ovaries make much less estrogen, which is why symptoms often ease.

Still, the body continues to make small amounts of estrogen, and factors such as menopause hormone therapy (also called hormone replacement therapy or HRT) may affect symptoms.

What Are the Symptoms of Premenopausal Endometriosis?

Pelvic pain is the most common symptom of endometriosis. Before menopause, pain often gets worse before or during a period because hormone changes can increase inflammation.

Other symptoms may include:

Painful menstrual cramps — Cramping may be intense or affect daily life.
Dyspareunia (pain during sex) — This may affect about half of women with endometriosis.
Bowel or bladder pain — Pain may occur during bowel movements or urination.
Digestive symptoms — Bloating, diarrhea, constipation, or nausea may occur.
Heavy bleeding — Some women have heavy periods or spotting between periods.
Fertility problems — Endometriosis can make it harder to get pregnant.

Some women with endometriosis have no symptoms. Symptoms also don’t always match how much endometriosis there is. A woman with a small amount of endometriosis may have a lot of pain, while another woman with more widespread endometriosis may have few symptoms.

What Are the Symptoms of Postmenopausal Endometriosis?

Endometriosis after menopause may not cause the symptoms many women associate with endometriosis, such as period-related pelvic pain or painful menstrual cramps, because menstrual periods have stopped.

After menopause, symptoms may be harder to connect directly to endometriosis. They can overlap with symptoms of other health conditions and may include:

Pelvic or abdominal pain
Changes in bowel habits
Bladder symptoms
Pain during sex
A pelvic mass (an abnormal growth or lump) found on imaging tests
Vaginal bleeding

What Conditions Can Cause Similar Symptoms?

Several conditions can cause symptoms that overlap with endometriosis. That’s one reason it’s important to talk with a doctor to get an accurate diagnosis.

Symptoms that feel like endometriosis may be caused by:

Fibroids — Benign (noncancerous) growths in the uterus that can cause pressure or bleeding.
Adenomyosis — A condition in which tissue similar to the uterine lining grows into the muscle wall of the uterus.
Ovarian cysts — Fluid-filled sacs that can cause pelvic pain or pressure.
Pelvic floor problems — Tight or painful pelvic muscles can contribute to chronic pelvic pain.
Bladder conditions — Urinary tract infections or painful bladder syndrome can cause pelvic and urinary symptoms.
Bowel conditions — Irritable bowel syndrome or inflammatory bowel disease (IBD) can cause pain, bloating, diarrhea, or constipation.
Gynecologic cancers — Some cancers can cause pelvic pain, bloating, bleeding, or changes in bowel or bladder habits.

What Usually Happens to Endometriosis During Menopause?

Many women find that endometriosis symptoms improve after menopause.

This improvement doesn’t always happen right away. Perimenopause is the transition to menopause, which can last several years. During this time, estrogen levels can rise and fall, which may make symptoms feel uneven or unpredictable. For some women living with endometriosis, symptoms may continue during this transition.

Menopause means you’ve gone 12 months in a row without a menstrual period. The ovaries produce much less estrogen, and endometriosis often becomes less active.

Can Endometriosis Continue After Menopause?

Yes. If you’ve already had endometriosis, it can continue after menopause, although it’s less common than endometriosis before menopause.

A 2024 review notes that postmenopausal endometriosis can affect up to 4 percent of women, compared with about 10 percent of women of reproductive age.

“My experience is that endometriosis does not go away. I went into menopause at an early age,” one MyEndometriosisTeam member reported. “I still suffered from flare-ups of symptoms from endo and painful intercourse. It never goes away.”

Can Endometriosis Develop After Menopause?

Endometriosis can rarely be diagnosed for the first time after menopause. In some cases, it may be truly new. In other cases, it may have been present before menopause but not diagnosed until symptoms appeared or imaging was performed later.

Risk Factors for Endometriosis After Menopause

Like endometriosis before menopause, postmenopausal endometriosis is thought to be influenced by estrogen. Factors that raise estrogen levels or act like estrogen may increase the likelihood of endometriosis symptoms after menopause.

Possible risk factors include:

Hormone therapy — Estrogen-containing treatment may reactivate remaining endometriosis in some women.
Obesity — Body fat can make small amounts of estrogen after menopause.
Tamoxifen use — This breast cancer medication can act like estrogen in some gynecologic tissues.
A history of endometriosis before menopause — Newly diagnosed endometriosis after menopause is much less common than continued endometriosis after menopause.

How Is Endometriosis After Menopause Diagnosed?

Diagnosis usually starts with a conversation about symptoms and medical history. Your doctor may ask about:

A history of endometriosis
Past surgeries
Hormone therapy use
Family history
Pain
Vaginal bleeding
Bowel symptoms
Bladder symptoms

If endometriosis is suspected, additional testing may be recommended.

Pelvic Exam

A pelvic exam may help your doctor check for tenderness, masses, reduced movement of pelvic organs, or visible signs of endometriosis.

Imaging Tests

One type of imaging test is a transvaginal ultrasound. During this test, a small probe is placed in the vagina to create pictures of the pelvic organs.

A transvaginal ultrasound is often used to look for:

Ovarian cysts
Deep infiltrating endometriosis (endometriosis that grows deeper into nearby tissues)
Other causes of symptoms

If a transvaginal ultrasound isn’t suitable, an abdominal pelvic ultrasound may be used.

An MRI may be considered when deep infiltrating endometriosis is suspected, especially if the bowel, bladder, or ureter may be involved. The ureters are tubes that carry urine from the kidneys to the bladder.

Laparoscopy and Biopsy

Laparoscopy is a surgery that lets a doctor look inside the pelvis with a small camera. A biopsy means removing a small tissue sample to check it under a microscope. In some cases, laparoscopy with biopsy may be used to confirm a diagnosis of endometriosis.

After menopause, doctors may check carefully for other possible causes, including cancer. This doesn’t mean cancer is likely. However, because new pelvic symptoms after menopause can have several possible causes, they deserve careful evaluation.

How Is Endometriosis After Menopause Treated?

Treating endometriosis is important because it can affect quality of life. Although there is no cure for endometriosis, treatment may help reduce symptoms and make daily life easier.

Treatment options depend on a person’s:

Symptoms
Age
Overall health
Past surgeries
Imaging results
Personal preferences

Surgery is often the preferred first treatment for endometriosis after menopause because it can remove endometriosis tissue, confirm the diagnosis, and help rule out other conditions.

If surgery isn’t a good option, doctors may consider other approaches. These may include:

Using pain relievers
Adjusting or stopping hormone therapy
Using medicines that lower estrogen activity, such as aromatase inhibitors

When Should You Talk to Your Doctor?
Talk to your doctor if you have pelvic pain, pain during sex, painful bowel movements, pain with urination, bloating that doesn’t go away, or symptoms that interfere with daily life. Keeping a pain and symptom diary can make these conversations easier. Call your doctor immediately if you have vaginal bleeding after menopause, blood in your urine or stool, a new pelvic mass, worsening pain, or unexplained weight loss. These symptoms may be related to a serious diagnosis, and your doctor can help find out what’s going on.

When Should You Talk to Your Doctor?

Talk to your doctor if you have pelvic pain, pain during sex, painful bowel movements, pain with urination, bloating that doesn’t go away, or symptoms that interfere with daily life. Keeping a pain and symptom diary can make these conversations easier.

Call your doctor immediately if you have vaginal bleeding after menopause, blood in your urine or stool, a new pelvic mass, worsening pain, or unexplained weight loss. These symptoms may be related to a serious diagnosis, and your doctor can help find out what’s going on.

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