It makes sense to think that when you stop having periods, chronic conditions of your female reproductive organs will also go away. But that isn’t necessarily true.
Here’s a look at how three women’s reproductive conditions may – or may not – change after menopause:
Endometriosis After Menopause
In endometriosis, tissue that is similar to the uterine lining grows outside the uterus, the Endometriosis Association explains. Like it does inside the uterus, the tissue builds up and then sheds each month. But when the tissue is outside of the uterus, it can’t exit through the vagina and gets trapped in the body, causing pain and inflammation, the formation of scar tissue, and bowel problems.
Endometrial tissue needs the hormone estrogen to grow. When you go through menopause naturally, your ovaries produce less estrogen. And if you have surgery and your ovaries are removed, you no longer produce as much estrogen. As a result, your symptoms may lessen, the association notes. However, your body still produces some estrogen, and that can cause your symptoms to persist.
If you have endometriosis and you take hormone replacement therapy after your ovaries are removed, your symptoms may even worsen, according to the association.
What happens could depend on the severity of your symptoms before menopause. “If your endometriosis is mild, it may get better with menopause,” says Kenny Sinervo, MD, of the Center for Endometriosis Care in Atlanta, Georgia. But if your disease is severe, symptoms are more apt to persist, he says.
How long you’ve had painful symptoms is also an indication of how likely it is that you will improve with menopause. “If you had 20 years of painful symptoms, odds are it’s not going to go away with menopause,” Dr. Sinervo says.
If your symptoms of endometriosis continue after menopause and they are affecting the quality of your life, he says, surgery may be the best treatment. Surgery to cut out all the endometriosis patches is often the best option, and typically more effective than medication, he says.
Fibroids After Menopause
Fibroids are usually noncancerous growths in the uterus that can cause abnormal bleeding, according to UCLA Health. The hormones estrogen and progesterone stimulate their growth. When fibroids are large, they can cause discomfort and pain as well.
You might think that fibroids will shrink or disappear once you’ve gone through menopause because your hormone levels drop dramatically. But that’s not always the case, says Matthew Siedhoff, MD, director of minimally invasive gynecologic surgery at the University of North Carolina at Chapel Hill. “And if a woman chooses hormone replacement therapy (HRT) after menopause, she could still experience bleeding symptoms and even fibroid growth after menopause,” Dr. Siedhoff says.
If your fibroids aren’t causing symptoms after menopause, don’t do anything, Siedhoff advises. But if your fibroids change in size or you start bleeding and are not on hormone replacement therapy, see your doctor to explore the cause.
Symptoms include pelvic pressure similar to period cramps, urgency to urinate when fibroids press on the bladder, and abdominal bloating when fibroids grow large.
If your fibroid symptoms are bothersome after menopause, you should consider surgery options, Siedhoff says. In some cases, interventional radiologists can perform procedures known as embolization that shrink fibroids by cutting off their blood supply, according to the NYU Langone Medical Center Department of Radiology. These procedures are not recommended in menopausal women, though, “because the fibroids have already shrunk as much as they’re going to,” Siedhoff says.
The best option is often surgery because it is the most effective, he says — either a hysterectomy, which removes the uterus, or a myomectomy, which removes just the fibroids, as the University of California San Francisco Medical Center explains.
Polycystic Ovary Syndrome and Menopause
Polycystic ovary syndrome (PCOS) is a hormonal disorder in which a woman’s ovaries produce more androgens, commonly known as male hormones, than she needs. As a result, a woman can have irregular menstrual cycles (or lack them completely), body-hair growth in unwanted places, thinning scalp hair, weight gain, and insulin resistance, according to the Department of Health and Human Services (HHS).
Some of these symptoms, such as excessive body-hair growth and thinning scalp hair, may get worse after menopause.
On the other hand, after menopause you no longer need treatments to bring on your period, says Maryam Siddiqui, MD, an assistant professor of obstetrics and gynecology at University of Chicago Medicine.
However, PCOS puts women at greater risk for cardiovascular disease, diabetes, high blood pressure, and sleep apnea, notes HHS. Aging also increases your risk for these conditions. That’s why as women with PCOS grow older and go through menopause, they need to be even more vigilant about managing risk factors for these other serious health issues, Dr. Siddiqui says.
If you have PCOS, ask your doctor about screening for high cholesterol and diabetes. Also, keep tabs on your blood pressure and weight.