Endometriosis and menopause: does it actually go away?

Does endometriosis go away after menopause?

Often it becomes much less active, because estrogen falls. But it doesn't disappear for everyone. A 2025 European Menopause and Andropause Society (EMAS) clinical guide estimates that about 2–5% of postmenopausal women have endometriosis. Pelvic pain after menopause deserves investigation rather than being dismissed as "impossible."

Why are people with endometriosis more likely to have early or surgical menopause?

In a pooled analysis of almost 280,000 women from five cohorts, cited by EMAS, endometriosis was linked to about a 7.5-fold higher risk of surgical menopause, which came on average 1.6 years earlier, and 36% higher odds of spontaneous premature ovarian insufficiency. Removing both ovaries causes sudden menopause, which tends to bring more intense symptoms than the gradual version.

Can I take hormone therapy if I've had endometriosis?

Many people can — the question is which kind. Estrogen on its own can stimulate remaining endometriosis, and long-term estrogen-only therapy is a risk factor for rare malignant change. So the 2022 ESHRE endometriosis guideline says clinicians should avoid estrogen-only regimens for hot flushes in people with an endometriosis history (a strong recommendation), and may consider combined estrogen plus progestogen after natural or surgical menopause. After surgical menopause, it suggests continuing combined therapy at least until the age of natural menopause. The 2025 EMAS guide prefers continuous combined therapy whether or not you've had a hysterectomy.

This is different from the usual rule that people without a uterus take estrogen alone — which is exactly why it's worth making sure whoever prescribes your hormone therapy knows your endometriosis history.

Does ADHD make perimenopause worse?

The research is new and mixed. In a large Icelandic study of women aged 35–55, 54% of those with ADHD reported severe perimenopausal symptoms, compared with 30% of those without. A UK survey of 656 women found no clear effect of an ADHD diagnosis itself, though higher ADHD symptom scores went along with more menopause difficulties. Both studies are a single snapshot in time and rely on self-report, so this is a signal worth watching, not an established fact.

What happens to hypermobility after menopause?

We don't really know. Hormones and menopause have been largely missing from hypermobility research. In one French cohort of 386 women with hypermobile EDS, about 65 were postmenopausal, and 22% of them said their symptoms improved after menopause. That's a small group recalling their own experience, so it can't tell us what usually happens. Treat any confident claim either way — "it gets worse" or "it gets better" — with caution.