Endometriosis Can Increase Your Risk Of Early Menopause—Here's What You Need To Know

I’ve been trying to get pregnant naturally for 12 years. Over the last decade, I’ve been diagnosed with multiple conditions, including polycystic ovarian syndrome (PCOS), chronic endometritis, hypothyroidism, luteal phase defect, LUFs, and endometriosis. 

Hypothyroidism and endometriosis run in my family, so I wasn’t exactly surprised to be diagnosed with those. But I was surprised when I tested my anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) levels (two hormones typically used to measure your ovarian reserve) on a whim at age 34 and found they were pointing to early menopause. Surprised is probably too weak a word – I was shocked and panicked. (And of course, that’s when my mom told me that early menopause also runs in our family. Yay.)

Those blood test results threw me into a rabid research session. What could cause a 34-year-old woman to have early menopause? Providentially, I stumbled across a study that showed a link between endometriosis and early menopause. 

Endometriosis and Menopause

But before I get into the study, let’s review what endometriosis is and what triggers menopause.

Endometriosis is an autoimmune disease where cells similar to (but not the same as) the cells of the uterine lining are found outside the uterus. These misplaced cells grow into endometriosis lesions and typically affect reproductive and pelvic organs, though endometriosis has also been found in the heart, lungs, and brain. Endometriosis lesions grow and bleed throughout the cycle, similar to the uterine endometrium. Endometriosis is a full-body, inflammatory disease, rooted in immune dysfunction. It can be progressive, and it can create scar tissue and adhesions inside the body. The symptoms of endometriosis are many; they range from no symptoms except infertility (called silent endo) to pelvic pain at any time of the cycle, bloating, joint pain, back pain, digestive problems, heavy periods, chronic fatigue, celiac disease, and more. Some cases of endometriosis can be managed and even put into remission through anti-inflammatory lifestyle changes; other cases require surgery to cut out the lesions (excision).

Menopause is the end of female fertility and is determined by the absence of a period for 12 consecutive months. Historically, menopause was thought to be caused by running out of eggs, but research shows that women still have over 1,000 eggs left at menopause. Instead, normal menopause is caused by the decline of ovarian hormonal production (estrogen, progesterone, and testosterone) that governs ovulation and menstruation.

The average age of menopause is 51, and early menopause happens between the ages of 40 and 45. Before true menopause, there is the perimenopause period, which can last up to 10 years. In perimenopause, you experience irregular cycles and symptoms of lower estrogen, like the classic hot flashes.

I do want to add that your AMH level (which is a measurement of a hormone created by granulosa cells in ovarian follicles) can fluctuate and it can also be improved. It’s not a death knell to your fertility, but it may be an indicator of the current state of your fertility. 

How Endometriosis Contributes to Early Menopause

While there haven’t been many investigations into the connection between endometriosis and early natural menopause, a 2022 study called “Association Between Laparoscopically Confirmed Endometriosis and Risk of Early Natural Menopause” found that women diagnosed with endometriosis, especially those who had never used oral contraceptives or who had never given birth, were more likely to experience early natural menopause. 

The researchers examined data from the Nurses’ Health Study II, which is one of the largest studies on risk factors for major diseases in women. Participants completed questionnaires every two years from 1989 to 2015, detailing if they had been diagnosed with endometriosis or experienced menopause. The women in the study were followed until they began early natural menopause, turned 45, had a hysterectomy, had ovaries removed, got cancer, died, or reached the follow-up in 2017.

The researchers discovered a 30% increased relative risk of early natural menopause in women with endometriosis.

The researchers discovered a 30% increased relative risk of early natural menopause in women with endometriosis, after controlling for race, education, income, smoking, diet, and body mass index, says Dr. Madhavi Kulkarni, lead author and researcher in the department of obstetrics, gynecology, and reproductive biology at Michigan State University in East Lansing.

So this study found “a statistically significant association,” but it didn’t explain why. One reason could be that endometriosis is highly toxic. It changes the abdominal environment through inflammation and can directly negatively affect ovarian and egg health.

Another factor that could trigger early menopause is surgery on the ovaries. I’ve had two excision surgeries to remove endometriosis lesions. My first surgery also operated on both ovaries to remove ovarian cysts (called an ovarian wedge resection) due to my PCOS, as well as to remove an endometrioma (an endometriosis cyst in or on the ovary) from inside my right ovary. My right ovary now looks like a pathetic little raisin compared to my left ovary.

A 2011 study called “Ovarian Surgery for Bilateral Endometriomas Influences Age at Menopause” found that cutting out endometriomas is associated with early natural menopause. The larger the endometrioma, the more ovarian tissue would be removed, and thus, the larger the risk. If endometriomas were in both ovaries, then menopause would occur earlier compared to women who had an endometrioma in only one ovary (42 years old versus 47 years old). If only one ovary was affected, the healthy ovary seemed to compensate.

The takeaway is we need healthy ovarian tissue to make adequate reproductive hormones to continue to cycle, and endometriosis and/or endometriomas can damage our ovaries.

Closing Thoughts

If you have a similar health situation with endometriosis, just be aware that your window for having children may be smaller. I was blindsided by this discovery, and even though I was already working to resolve my infertility, it still shook me to learn I might have less time than I originally thought to work with.

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