From adolescence and fertility to pregnancy, menopause and lifelong care

Endometriosis can change as life changes. Symptoms, fertility priorities, hormone exposure and treatment needs may be very different during adolescence, the reproductive years, pregnancy, perimenopause and after menopause. The diagnosis may remain the same, but the care plan should evolve with the patient.

1. Adolescence: endometriosis can begin early

Endometriosis can begin during adolescence, sometimes soon after periods start. Severe period pain, repeated school absence, pelvic pain, or cyclical bowel or bladder symptoms should not be dismissed because of young age. Early recognition matters. Young patients with suspected or confirmed disease may benefit from care through an adolescent gynecology or specialist endometriosis service.

2. The reproductive years

Symptoms and priorities may change through the reproductive years. Pain control, work or school, relationships, fertility plans and the location or extent of disease can all influence treatment. There is no single treatment pathway for every woman or every stage of life. Care should be reviewed when symptoms or priorities change.

3. When pregnancy is desired

Endometriosis does not automatically mean infertility. Options may include natural conception, intrauterine insemination (IUI), in vitro fertilization (IVF) or fertility preservation. Age, ovarian reserve, tubal and partner factors, disease and previous surgery help determine an individualized plan.

4. Endometriosis during pregnancy

Pregnancy is not a treatment or cure. Symptoms may improve, stay the same or worsen, and lesions may change. Most women should not be discouraged from pregnancy because of endometriosis alone. Significant abdominal pain or bleeding in pregnancy needs prompt assessment; severe pain or fainting needs emergency care.

5. After pregnancy and childbirth

After delivery, symptoms may remain improved for a time, return when menstrual cycles resume, or follow a different pattern. Breastfeeding and postpartum hormonal changes can delay menstruation, but they do not guarantee that endometriosis has disappeared. Persistent or recurrent symptoms should be reassessed rather than assumed to be a normal part of recovery.

6. Between pregnancies

For women who hope for another pregnancy, the interval after childbirth can be an important time to review symptoms, ovarian reserve when relevant, previous operative findings and future fertility plans. Decisions about hormonal suppression, trying naturally, fertility treatment or additional surgery should reflect the individual's goals and disease history.

7. Perimenopause

During the years approaching menopause, menstrual cycles and hormone levels become less predictable. Endometriosis symptoms may improve, persist or fluctuate. New bleeding, a new pelvic mass, or substantially changing pain should not automatically be attributed to known endometriosis; other gynecologic conditions become increasingly important to consider with age.

8. Menopause: symptoms often improve, but not always

Endometriosis is estrogen-responsive, so symptoms often decrease after natural menopause. However, endometriosis can remain active or symptomatic after menopause. New or persistent pelvic pain, bleeding or a pelvic mass deserves evaluation rather than being assumed to be old endometriosis.

9. Menopausal hormone therapy

Menopausal hormone therapy may help symptoms when appropriate. For a history of endometriosis, ESHRE advises avoiding estrogen-only regimens and considering combined estrogen-progestogen therapy, including after hysterectomy. Evidence is limited: discuss personal benefits, risks and contraindications with your clinician.

10. Does hysterectomy cure endometriosis?

Hysterectomy removes the uterus and ends the ability to carry a pregnancy. It does not necessarily remove endometriosis elsewhere or cure pain. If chosen, discuss treatment of visible disease, fertility consequences and whether the ovaries should be retained. Removing both ovaries has additional long-term effects.

11. After removal of the ovaries

Removing both ovaries before natural menopause causes surgical menopause, with effects on bone, cardiovascular and sexual health. ESHRE supports combined estrogen-progestogen treatment to the usual age of menopause when appropriate. This needs individualized review of contraindications and other risks.

12. Endometriosis is a lifelong care journey

Endometriosis may present differently at 15, 30, 45 or after menopause. The important principle is that care should evolve with the patient. Symptoms, fertility goals, previous surgery, ovarian reserve, menopause and overall health should be reconsidered over time rather than relying indefinitely on a plan made years earlier.

Evidence & references

Endometriosis Through Different Stages of Life
Version 1.1 · Reviewed 13 September 2026

Life stages and pregnancy

Endometriosis can occur in adolescence and persist after menopause. Pregnancy and hysterectomy are not reliable cures. Fertility choices and follow-up should reflect the person's stage of life and goals.

Menopausal hormones

ESHRE advises avoiding estrogen-only therapy in women with a history of endometriosis and allows combined therapy when appropriate. Supporting evidence is limited; contraindications and individual risks still apply, including after surgical menopause.

Full references

• [S01] ESHRE. Endometriosis guideline. 2022. Freely available
• [S13] WHO. Endometriosis. Fact sheet, 15 October 2025. Freely available
• [S08] NHS. Laparoscopy (keyhole surgery). Reviewed 20 December 2023. Freely available

No listed institution endorses GEM.

Medical information

Do not delay care; seek emergency help for a suspected emergency.