Endometriosis associated with premature and early menopause

By Melanie Hinze

Women with endometriosis are more likely to undergo surgical menopause and experience menopause at a younger age than women without endome­triosis, according to a large pooled cohort study.

The international study, published in Human Repro­duc­tion, analysed data from 279,948 women across five longitudinal cohort studies conducted in the UK, Australia, Sweden and Japan between 1996 and 2022. Researchers examined associa­tions between endometriosis and both the type and timing of menopause. Endometriosis was identified in 3.7% of participants via self-report and administrative records.

The study found women with endometriosis were over seven times more likely to undergo surgical menopause and were less likely to experience natural menopause than those without.

Timing also differed, with patients with endometriosis experienc­­ing surgical meno­pause 1.6 years earlier on average, and natural menopause about five months earlier. Women with endometriosis were also twice as likely to experience premature surgical menopause (before age 40 years) and 1.4 times more likely to develop spontaneous premature ovarian insufficiency.

The researchers recom­mended long-term monitoring and tailored reproductive counselling for women with endometriosis, given the health implications of premature or surgical menopause.

Dr Amie Hanlon, Specialist Gynaecologist at Greenslopes Obstetrics & Gynaecology, Brisbane, and Queensland Director on the Board of the Australasian Menopause Society, said this research affirms the fact that endome­triosis, and its treatments, can contribute to earlier menopause.

‘Pelvic surgery is a known risk factor for earlier meno­pause, and many patients with endometriosis unfortunately require multiple surgeries throughout their lives,’ she said.

Additionally, she noted that endometriosis was one of the most common reasons younger patients had their ovaries removed for benign reasons.

‘The minute a patient has both ovaries removed … the menopausal symptoms can come on hard and fast for these patients, but even if they don’t have much in the way of symptoms, we still need to replace their hormones. The younger the patient is, the more impor­tant this is for future health reasons, including prevention of osteoporosis and cardiovascular disease,’ said Dr Hanlon.

‘If a patient is considering having both ovaries removed as part of their treatment before the natural age of menopause, or this is a possibility discussed with them by their surgeon, it would be ideal if they could be seen by a menopause specialist before the surgery occurs,’ she added.

This would give patients an idea of what the consequences of that surgery might be, and how their resulting menopause could be treated, she said.

‘I would also encourage healthcare professionals to look at the Australasian Menopause Society information sheet on surgical menopause [https://www.menopause.org.au/hp/information-sheets/surgical-menopause], and the recently updated European Society of Human Reproduction and Embryology (ESHRE) Guide­line on Premature Ovarian Insufficiency [https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Premature-ovarian-insufficiency]. The Australasian Menopause Society website also contains links to the ESHRE guidelines and patient informa­tion,’ she said.

Hum Reprod 2025; 00: 1–10; https://doi.org/10.1093/humrep/deaf068.