Endometriosis During Peri-Menopause and Post-Menopause: A Review of the Literature

Endometriosis is traditionally regarded as a condition predominantly affecting women of reproductive age, often associated with infertility and cyclical pelvic pain. As a result, a significant body of research and clinical attention has been directed toward the younger patient population. However, there is growing recognition that endometriosis can persist or even arise anew in peri-menopausal and post-menopausal women, yet the impact of the disease in this group remains underappreciated. Many women may have lived with undiagnosed or misdiagnosed endometriosis for decades, often being reassured that period pain and pelvic discomfort were normal aspects of menstruation, and therefore not subjected to appropriate investigation or intervention. This review aims to highlight the clinical significance of endometriosis in peri-menopausal and post-menopausal women. We will examine the common symptoms encountered in this population, discuss current strategies and challenges in diagnosis, and review evidence-based approaches to management. Special consideration will be given to the complex interface between endometriosis and HRT, as well as the potential risk of malignant transformation. Finally, drawing from existing guidelines and expert opinion, we propose recommendations for the diagnosis, treatment, and long-term follow-up of these patients, with the goal of improving outcomes and quality of life for this often overlooked cohort of women.