Endometriosis is a condition where the womb lining (endometrium) is in abnormal places including on the ovaries, bowel and sometimes further afield. Currently it is not known why this happens, but could be genetic, or due to immunological or hormonal reasons.
It is difficult to know how many people this affects, as symptoms can vary and often it can go undiagnosed. It’s thought that the condition affects between 1 in 10 and 5 in 10 women, often between the age of 25-40.
Generally, those who have induced menopause for the treatment of endometriosis (either surgically or chemically) are younger and therefore would benefit from HRT if they have no contra-indications. This is important to protect against osteoporosis and heart disease.
In addition, it can help with menopausal symptoms such as hot flushes, mood changes, anxiety, low libido, memory loss, hair loss, joint aches and urinary / vaginal symptoms.
Women who have not had induced menopause for endometriosis may want to consider HRT when they are perimenopausal / menopausal for symptom relief.
Any woman with endometriosis who still has a womb should be offered continuous combined HRT. This means taking oestrogen and progesterone every day continuously. This is to ensure that any remaining endometriotic tissue is not flared up causing symptoms. A good option is the Mirena IUS (patch, gel or spray), which controls symptoms and can be used as the progesterone part of HRT.
If you have had a hysterectomy due to endometriosis, it is initially advised to start continuous combined HRT with oestrogen and progesterone every day, until the natural age of menopause (around 51).
Normally if you have had a hysterectomy, you only need oestrogen. However, there is a small risk of inducing a flare up of any tissue which hasn’t been removed, so progesterone is recommended alongside oestrogen for at least a couple of years until the natural age of menopause.
Oestrogen-only HRT can then be considered, as it is thought to be lower risk than combined HRT, but it has to be weighed up with the risk of flaring up endometriosis. It’s a good idea to discuss this with your doctor or menopause specialist.
Tibolone is another option, which is not often used but can be helpful in women with endometriosis. It is a tablet which contains oestrogen, progesterone and testosterone properties which can be helpful in women with a low libido. It has similar risks to oral HRT, which has a small increased risk of stroke, blot clot and breast cancer.
If women have dry vaginal symptoms then vaginal oestrogen can be used safely in the long term. This comes in the form of cream or a tablet. You do not need to use progesterone alongside vaginal oestrogen
Endometriosis can be a debilitating condition, which is why it’s important to diagnose and manage it appropriately. If you have endometriosis and you’re approaching perimenopause or menopause, make sure you flag this to your doctor or menopause specialist so that you get the right care.
