--- title: 'Understanding What Happens In Perimenopause When You Have Endometriosis' slug: endometriosis-perimenopause-symptoms-hrt lifeStage: perimenopause category: Cycle author: 'Samaira Farid' medicalReviewer: 'Dr Shree Datta, Consultant Obstetrician and Gynaecologist ' reviewerId: 'https://blog.bloume.com/perimenopause/medical-board.md#dr-shree-datta' lastUpdated: '2026-08-29' primarySource: 'NICE NG73: Endometriosis: diagnosis and management' wordCount: 1233 readTimeInSeconds: 308 --- # Understanding What Happens In Perimenopause When You Have Endometriosis If you live with endometriosis, perimenopause brings its own set of changes worth knowing about ahead of time. Symptoms do not always simply ease. The hormonal swings of perimenopause can shift your pain patterns, and if you start Hormone Replacement Therapy (HRT), there are specific things to weigh up around how oestrogen interacts with endometriosis tissue. This article covers what to expect as oestrogen levels change, how HRT is usually approached, and what to raise with your GP. **Q: Will my endometriosis symptoms get better when I reach menopause?** A: For most people, symptoms do ease once oestrogen levels settle after menopause. The lead-up to it can be bumpier though, as swinging oestrogen levels can flare symptoms for a while. An estimated 2 to 5% of people keep having symptoms after menopause, particularly with severe disease or significant scarring. Your GP or specialist can give you a clearer picture based on your history. If you live with endometriosis, you may have been told that menopause will bring relief. For many people, it does. The years leading up to it can feel less predictable though, with pain that flares, symptoms you have not had before, and questions about whether Hormone Replacement Therapy (HRT) is the right move for you. The hormonal swings of perimenopause, particularly oestrogen spikes, can make endometriosis symptoms worse before they settle. Understanding what is happening, and what your options are around HRT, puts you in a stronger position to make decisions alongside your doctor. ## How endometriosis symptoms can shift in perimenopause If your symptoms had felt manageable for a while, perimenopause can catch you off guard. Oestrogen does not simply taper off in a smooth line. It swings, sometimes climbing higher than before, then dropping again. Those spikes can stir up any remaining endometriosis tissue and bring flare-ups back. The pain itself can change shape. Instead of arriving and leaving with your period, you may notice it sticking around, less tied to your cycle and spread across more of the month. Because this kind of pain overlaps with other conditions, any new or shifting pattern is worth raising with your GP rather than working out on your own. Because oestrogen levels fall during menopause, many women experience relief from endometriosis symptoms. In some cases, however, new symptoms can show up or existing ones can feel different. You may notice painful bowel movements, a sudden urge to urinate, or pain during sex, either for the first time or more strongly than before. Because these symptoms overlap with conditions like irritable bowel syndrome and urinary tract infections, it helps to discuss them with your GP to identify the cause rather than managing them alone. > **INFO**: Symptoms ease for most people once menopause arrives. For an estimated 2 to 5% of postmenopausal women, they carry on, particularly with severe disease or extensive scarring. Menopause does not clear things completely for everyone. ## HRT and endometriosis: what the interaction means for you HRT does a lot to ease perimenopausal and menopausal symptoms, and it carries longer-term benefits too, like supporting your bone density, with possible benefits for your heart in the right circumstances. These matter especially if you have had an early or surgical menopause. With a history of endometriosis, there is one thing to weigh up: the oestrogen in HRT can wake up dormant endometriosis tissue and bring symptoms back. That shapes how HRT is usually prescribed for you. ### Why progestogen is included A combination of oestrogen and progestogen is standard for women with a womb, as progestogen helps prevent an unwanted buildup of the womb lining. For those who have had a hysterectomy, HRT is generally oestrogen-only. However, if you have a history of endometriosis, it is worth discussing with your doctor whether adding a progestogen is still recommended, as it can help reduce the risk of remaining endometriosis tissue reactivating. Continuous combined HRT means taking oestrogen and progestogen together every day, without a break. Clinical guidance points to this approach when you have endometriosis, and that holds true even after a hysterectomy. Standard HRT after a hysterectomy is usually oestrogen-only. Where endometriosis is part of your history, the combined approach helps keep any remaining tissue from reactivating. It is a specific point worth raising with your clinician, since the right path depends on your history and how endometriosis has affected you. ### The levonorgestrel IUS as a progestogen option A levonorgestrel intrauterine system (IUS), a small device placed in your womb that releases progestogen, such as the Mirena, may be worth discussing with your doctor. This is something for you and your doctor to work through together, weighing up your symptoms, your history, and what fits your life. > **WARNING**: If pelvic pain or other endometriosis symptoms show up while you are on HRT, call your GP for an assessment. It can be a sign that your HRT needs reviewing. If you are not sure how urgently you need to be seen, call NHS 111. ## Monitoring after menopause There is a very small chance that endometriosis tissue can turn cancerous. Because of this, any new lump in your pelvis or symptoms that linger after menopause need looking into rather than a wait-and-see approach. This is rare, and it is the reason to stay in touch with your healthcare team and to take any new symptoms seriously rather than brushing them off as routine. ## What to discuss with your GP Endometriosis and perimenopause share a lot of symptoms, and telling them apart is hard to do on your own. Keeping a detailed symptom diary, noting where the pain is, when it comes, how strong it feels, and anything new, gives your GP a clearer picture. It can help separate perimenopausal changes from an endometriosis flare-up. Bring this diary to your appointments along with your full gynaecological history. A few specific things are worth raising: whether HRT is right for you and, if so, which type; how your endometriosis history shapes the choice between oestrogen-only and continuous combined HRT; whether your current pain relief is still doing enough; and whether any new symptoms need looking into. If you have not yet had a proper conversation with your GP about how endometriosis affects your perimenopause care, including your HRT options, booking that in is a practical next step. Your full gynaecological history feeds directly into the decisions your clinician makes, so it is worth making sure it is part of the conversation. --- **Q: Will my endometriosis symptoms get better when I reach menopause?** For most people, symptoms do ease once oestrogen levels settle after menopause. The lead-up to it can be bumpier though, as swinging oestrogen levels can flare symptoms for a while. An estimated 2 to 5% of people keep having symptoms after menopause, particularly with severe disease or significant scarring. Your GP or specialist can give you a clearer picture based on your history. **Q: Can I take HRT if I have endometriosis?** HRT is an option for many people with endometriosis, and the type matters. The oestrogen in HRT can reactivate dormant endometriosis tissue, so continuous combined HRT (oestrogen and progestogen taken together each day) is usually the approach guidance points to when endometriosis is in your history. This holds true even after a hysterectomy, which differs from the usual oestrogen-only HRT given afterwards. Talk through your history with your GP or gynaecologist to work out what is right for you. **Q: How do I know if new symptoms are endometriosis or perimenopause?** A lot of symptoms overlap, including pelvic pain, bladder changes, and pain during sex. A detailed symptom diary noting timing, location, severity, and any patterns can help your doctor tell the two apart. Some of these symptoms also overlap with other conditions, so it helps to have them assessed properly rather than working it out yourself. Bring your diary to your next GP appointment. **Q: What should I do if my endometriosis symptoms return while I am on HRT?** Call your GP for an assessment. Symptoms like pelvic pain coming back can be a sign your HRT needs reviewing or adjusting. You do not need A&E for this unless your pain is severe and sudden, though it is best not to sit on it until a routine review either. Call NHS 111 if you are unsure how urgently you need to be seen. ### Clinical Sources - [NICE NG73: Endometriosis: diagnosis and management](https://www.nice.org.uk/guidance/ng73) - [Jo's Hot Topics: Endometriosis and Menopause](https://www.endometriosis-uk.org/jos-hot-topics-endometriosis-and-menopause) - [Menopause: A Guide for People With Endometriosis](https://endometriosisnetwork.com/endo-hub/menopause-a-guide-for-people-with-endometriosis/) - [Jo's Hot Topics: Endometriosis and Menopause](https://www.endometriosis-uk.org/jos-hot-topics-endometriosis-and-menopause) - [BMS Tools for Clinicians: Induced Menopause in women with endometriosis](https://thebms.org.uk/wp-content/uploads/2026/02/10-NEW-BMS-TfC-Induced-Menopause-in-women-with-endometriosis-FEB2026-B.pdf) - [Jo's Hot Topics: Endometriosis and Menopause](https://www.endometriosis-uk.org/jos-hot-topics-endometriosis-and-menopause) - [BMS Tools for Clinicians: Induced Menopause in women with endometriosis](https://thebms.org.uk/wp-content/uploads/2026/02/10-NEW-BMS-TfC-Induced-Menopause-in-women-with-endometriosis-FEB2026-B.pdf) - [Jo's Hot Topics: Endometriosis and Menopause](https://www.endometriosis-uk.org/jos-hot-topics-endometriosis-and-menopause) - [Endometriosis & Perimenopause](https://healthinmenopause.co.uk/endometriosis/) - [Jo's Hot Topics: Endometriosis and Menopause](https://www.endometriosis-uk.org/jos-hot-topics-endometriosis-and-menopause) - [BMS Tools for Clinicians: Induced Menopause in women with endometriosis](https://thebms.org.uk/wp-content/uploads/2026/02/10-NEW-BMS-TfC-Induced-Menopause-in-women-with-endometriosis-FEB2026-B.pdf) - [Menopause: A Guide for People With Endometriosis](https://endometriosisnetwork.com/endo-hub/menopause-a-guide-for-people-with-endometriosis/) --- Reviewed by Dr Shree Datta, Consultant Obstetrician and Gynaecologist | [Medical Board](https://blog.bloume.com/perimenopause/medical-board.md) | August 2026