Endometriosis in Elderly Women: A Comprehensive Guide
Endometriosis does not always disappear after menopause. Learn about symptoms, diagnosis, and safe treatment options for elderly women living with endometriosis.
Written by Dr. J T Hema Pratima
Reviewed by Dr. Rohinipriyanka Pondugula MBBS
Last updated on 10th Sep, 2025
Understanding Endometriosis Beyond the Reproductive Years
What is Endometriosis?
Endometriosis is a condition where tissue similar to the lining inside the uterus (the endometrium) grows outside of it. This tissue, known as endometrial implants, can be found on the ovaries, fallopian tubes, the outer surface of the uterus, the bowel, and other organs within the pelvis. Unlike the uterine lining that sheds during menstruation, this misplaced tissue has no way to exit the body. This leads to inflammation, the formation of scar tissue (adhesions), and severe, chronic pain.
Why Endometriosis is Not Just a "Young Woman's Disease"
The common misconception that menopause "cures" endometriosis stems from the fact that the implants are oestrogen-responsive. Since oestrogen levels plummet after menopause, it's logical to assume the disease becomes inactive. However, for many women, this isn't the case. Existing scar tissue and adhesions can continue to cause pain and organ dysfunction. Furthermore, low levels of oestrogen are still produced by fat cells and the adrenal glands, and sometimes through Hormone Replacement Therapy (HRT), which can be enough to fuel persistent disease.
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Symptoms of Endometriosis in Older Women
Common Symptoms and Their Overlap with Ageing
The symptoms of postmenopausal endometriosis are often mistakenly attributed to other age-related issues. This leads to significant delays in diagnosis and proper treatment. Common symptoms include:
Chronic Pelvic Pain: A constant, dull ache or sharp, stabbing pain in the lower abdomen.
Painful Intercourse (Dyspareunia): This can persist due to scar tissue and lack of elasticity.
Gastrointestinal Distress: Bloating, constipation, diarrhoea, and painful bowel movements can mimic Irritable Bowel Syndrome (IBS).
Urinary Issues: Painful urination, frequency, or urgency can be mistaken for UTIs or overactive bladder.
Fatigue and Malaise: Chronic pain is exhausting and can be misread as general age-related fatigue.
Atypical and Severe Symptoms to Watch For
In some cases, endometriosis in seniors can present more severely. Be vigilant about:
Postmenopausal Bleeding: Any bleeding after menopause is a red flag and must be investigated immediately to rule out endometrial or ovarian cancer.
Bowel or Bladder Obstruction: Large endometriotic implants on the bowel or bladder can, in rare cases, cause partial blockages.
Significant Pain with Routine Activities: Pain that is triggered by simple actions like sitting for long periods, bending over, or lifting light objects.
Unique Insight: A key difference in elderly women is that "cyclic" pain is often absent, making doctors less likely to consider endometriosis. The pain is often constant, changing in intensity but not disappearing, which is a crucial detail to communicate to a healthcare provider.
Causes and Persistence of Endometriosis After Menopause
The Role of Oestrogen (It's Not Gone Completely)
While ovarian production of oestrogen ceases after menopause, the body does not stop producing it entirely. Estrone, a type of oestrogen, is produced in adipose (fat) tissue. Therefore, women with a higher BMI may have a higher baseline level of oestrogen capable of stimulating endometrial implants. Furthermore, some Hormone Replacement Therapies prescribed to manage menopausal symptoms can inadvertently provide the fuel for persistent endometriosis.
Other Theories: Stem Cells and Autoimmune Factors
Emerging research suggests that endometriosis may be driven by stem cells or have an autoimmune component, which could explain its persistence independent of oestrogen. These theories are still being investigated but highlight the complex nature of the disease and why a one-size-fits-all approach, especially for elderly women, does not work.
The Critical Importance of Accurate Diagnosis
Why Diagnosis is Often Missed or Delayed
Diagnosis is frequently delayed in older women due to physician bias. The assumption that "it can't be endometriosis" due to age leads to other, often more serious, conditions being ruled out first, while endometriosis is never considered. Women themselves may not report symptoms, believing their pain is an inevitable part of growing older.
Diagnostic Tools: From Ultrasound to Laparoscopy
Transvaginal ultrasound can sometimes identify larger endometriomas (cysts on the ovaries) or deep infiltrating endometriosis. However, the gold standard for diagnosis remains laparoscopy – a minimally invasive surgical procedure where a camera is inserted into the abdomen to visually confirm and often treat the disease at the same time.
Ruling Out Other Conditions: Cancer, IBS, and Diverticulitis
This is the most critical step. Postmenopausal endometriosis symptoms can closely mimic those of ovarian or colorectal cancer. A thorough workup must include:
CA-125 blood test (though it can be elevated in both endometriosis and cancer).
Colonoscopy to rule out bowel cancer or diverticulitis.
Pelvic MRI for a more detailed view.
Biopsy of any suspicious tissue.
Treatment and Management Strategies for Seniors
Hormonal Therapies: Are They Still an Option?
Traditional first-line treatments for younger women (like birth control pills) are generally not suitable for elderly women. However, low-dose progesterone or aromatase inhibitors (which block oestrogen production throughout the body) can be considered under careful specialist supervision to manage symptoms without increasing other health risks.
The Role of Surgery: Hysterectomy and Excision
For many older women who have completed their families, surgery is a definitive option.
Hysterectomy with Bilateral Salpingo-Oophorectomy (BSO): Removal of the uterus, cervix, fallopian tubes, and ovaries. This eliminates the primary source of oestrogen and can be highly effective, especially if combined with excision of all visible endometriosis lesions.
Excision Surgery: A skilled surgeon cuts out the endometriosis implants and scar tissue while preserving healthy organs. This is often the preferred approach to preserve bowel and bladder function.
Pain Management and Complementary Approaches
A multi-modal approach to pain is essential:
NSAIDs: Over-the-counter options like naproxen can help with inflammation and pain.
Physical Therapy: Pelvic floor physical therapy can be incredibly effective at relieving pain caused by tight, scarred pelvic muscles.
Complementary Therapies: Acupuncture, mindfulness, and gentle yoga like restorative or yin yoga can help manage chronic pain and improve mental well-being.
Living with Endometriosis: Quality of Life and Support
Navigating the Emotional and Psychological Impact
Living with a chronic, "invisible" illness in later life can be profoundly isolating. The lack of awareness can lead to feelings of frustration and depression. Seeking support from a therapist who specialises in chronic illness or connecting with support groups (online or in-person) can provide validation and coping strategies.
Diet, Exercise, and Lifestyle Modifications
While not a cure, lifestyle changes can help manage symptoms:
Anti-inflammatory Diet: Reducing red meat, gluten, and processed foods while increasing intake of omega-3s (found in fish), leafy greens, and berries may help reduce inflammation.
Gentle Exercise: Walking, swimming, and stretching can improve circulation, reduce pain, and combat fatigue without putting strain on the body.
Stress Management: Chronic pain is exacerbated by stress. Techniques like meditation, deep breathing, and pursuing enjoyable hobbies are vital.
Conclusion
Endometriosis in elderly women is a challenging and often overlooked reality that demands greater awareness from both the medical community and the public. Dismissing persistent pelvic pain as an inevitable part of ageing can leave women suffering needlessly for years. The path to wellness involves understanding the unique presentation of the disease after menopause, advocating fiercely for a thorough and accurate diagnosis, and exploring a personalised management plan that prioritises quality of life. Remember, your pain is valid, and answers exist. By seeking knowledge and the right medical partners, you can find effective strategies to manage this condition and enjoy your later years with greater comfort and peace. If you suspect you might be dealing with postmenopausal endometriosis, take the first step today by speaking with a healthcare provider who listens.
Consult a Specialist for Personalised Advice
Consult a Specialist for Personalised Advice
Dr. Mona Yadav
Obstetrician and Gynaecologist
19 Years • MBBS, MD (Obstetrics & Gynaecology)
Dombivli
Nulife multispeciality, Dombivli
Dr. Asha Rani Singh
Obstetrician and Gynaecologist
24 Years • MBBS DGO
Delhi
Dr Asha Rani Singh Clinic, Delhi
Dr. Parul Sharma
Obstetrician and Gynaecologist
8 Years • MBBS, MS (Obstetrics & Gynaecology)
New Delhi
THE DOCTORS NESST, New Delhi
Dr. K Anusha
Obstetrician and Gynaecologist
4 Years • MBBS, DGO
Yemmiganur
SRINIVASAA HOSPITAL, Yemmiganur
Dr. Shyamala Devi
Obstetrician and Gynaecologist
38 Years • MBBS, MS Obstetrics & Gynaecology
Vijayawada
Sri Shivshakti Nilayam, Vijayawada
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Frequently Asked Questions
1. Can endometriosis suddenly appear after menopause?
While it's more common for endometriosis to persist from earlier years, it is possible for it to be newly diagnosed after menopause. This can sometimes be triggered by hormone replacement therapy (HRT) that contains oestrogen without a balancing progesterone.
2. Is endometriosis after menopause a sign of cancer?
Not necessarily, but the symptoms can be very similar. The most critical symptom to watch for is postmenopausal bleeding, which must always be investigated immediately by a doctor to rule out endometrial or ovarian cancer. Endometriosis itself is a benign condition, though it can be very painful
3. What is the best treatment for endometriosis in a 70-year-old woman?
The 'best' treatment is highly individual. For a 70-year-old, factors like overall health, heart health, and bone density are crucial. Often, a combination of gentle pain management, physical therapy, and sometimes minimally invasive excision surgery is considered. A hysterectomy is a larger surgery and is weighed against the risks and benefits for the patient's age and health status.
4. Does endometriosis get worse with age?
For most women, endometriosis symptoms improve after natural menopause due to lower oestrogen. However, for a subset of women, symptoms can persist unchanged or even worsen due to the long-term buildup of scar tissue and adhesions, which can cause pain regardless of hormonal activity.
5. Can I take HRT if I have a history of endometriosis?
It is possible, but it must be approached with extreme caution. An oestrogen-only HRT regimen is generally avoided as it can stimulate any remaining endometrial tissue. If HRT is necessary for severe menopausal symptoms, a combination of oestrogen and progesterone (progestin) is typically used, and you should be under the care of a gynaecologist who specialises in both menopause and endometriosis.