Endometriosis in Perimenopause and Menopause: What You Need to Know

Endometriosis is one of the most under-recognized causes of pain and infertility in women—and far too often, it’s dismissed or misunderstood.

At its core, endometriosis is a condition where tissue similar to the uterine lining (endometrium) grows outside the uterus. These implants have been found almost anywhere in the body—from the ovaries and pelvic lining to, in rare cases, even the eyes and spinal cord.

This tissue still responds to hormonal signals, which means it can bleed and inflame just like the uterine lining—except it has nowhere to go.

What Does Endometriosis Look Like?

Endometriosis can vary widely in severity. It’s classified from Stage 1 (minimal) to Stage 4 (severe), but here’s the important part:

👉 Stage does not always correlate with symptoms. Some women with minimal disease have severe pain, while others with advanced disease may have few symptoms.

Common symptoms include:

• Painful periods (often worsening over time)

• Pain with bowel movements

• Chronic pelvic pain

• Back pain

• Pain with intercourse

• Heavy or irregular bleeding

• Infertility

  
  

Endometriosis is:

• Present in ~10–15% of women

• Found in up to 70% of women with chronic pelvic pain

• Associated with ~25% of infertility cases

  
  

What Causes It?

We don’t have one single answer—but several patterns show up consistently:

• Hormonal influence (especially estrogen)

• Immune system dysfunction

• Genetic predisposition (it often runs in families)

• Possibly more common in redheads

• Environmental factors (toxins)

• Difficulty properly metabolizing estrogen

  
  

From a functional medicine perspective, I often think of endometriosis as a perfect storm:

Hormones + inflammation + immune dysregulation + detoxification challenges

Treatment Options (And Why None Are Perfect)

There is no one-size-fits-all treatment, and unfortunately, no universally “curative” option.

Common treatments include:

• Hormonal therapies

  • Birth control pills

  • Progestins

  • GnRH agonists like Lupron

• Surgery (removal of lesions)

• Tubal ligation

• Hysterectomy (most definitive—but still not always a guarantee)

  
  

Each approach has trade-offs, and the right plan depends on your symptoms, goals, and stage of life.

A Note on Hormone Therapy (HRT) and Endometriosis

I care for many women with a history of endometriosis, and this is an area where there is often a lot of confusion—and understandable concern.

Many of my patients have had prior pelvic procedures, which can sometimes lead to earlier onset of menopause. When that happens, we’re faced with an important question:Can we safely use hormone therapy?

In my experience, the answer is often yes—with thoughtful, individualized care.

All of my patients with a history of endometriosis who have started HRT have done well overall. That said, I approach estrogen dosing carefully and intentionally, and I monitor levels along the way.

I used to worry that estrogen might stimulate residual endometrial implants. Fortunately, this has not played out clinically for most of my patients. I have had one patient experience some recurrence of pelvic pain, and in her case, we adjusted (lowered) her estrogen dose—and she improved.

This is a good example of why close follow-up and personalization matter.

Endometriosis is not an absolute contraindication to hormone therapy, but it does require a more nuanced approach:

• Thoughtful estrogen dosing

• Ongoing symptom monitoring

• Willingness to adjust as needed

• 
  

With the right strategy, these women can absolutely feel better and safely benefit from hormone support.

Careful management is key—but it can be done well. 🙂

A Different Lens: Supporting the Body

In my practice, we often combine conventional options with lifestyle, nutrition, and targeted support—because inflammation and hormone metabolism matter.

Nutrition Strategies

These aren’t about perfection—they’re about reducing inflammation and supporting estrogen balance:

Consider limiting:

• Caffeine (very low intake, ideally <5000mg/month)

• Trans fats (good for everyone to avoid anyway)

• Red meat (especially processed)

• Gluten and dairy (common inflammatory triggers for some patients)

Increase:

• Fiber (helps eliminate estrogen)

• Cruciferous vegetables (broccoli, cauliflower, Brussels sprouts → support estrogen metabolism via indole-3-carbinol)

• High-sulfur foods (garlic, onions, eggs)

• Liver-supportive foods

  • Carrots

  • Beets

  • Artichokes

  • Dandelion greens

• Quercetin-rich foods

  • Apples

  • Onions

  • Berries

    
    

Supplements to Consider

These can be helpful—but should always be individualized:

• Vitamin C (start ~1000 mg/day, can increase gradually up to 10,000 mg/day if tolerated)

  Avoid in rosacea

• Beta carotene

• Vitamin E

  ⚠️ Can thin blood—avoid if on blood thinners

• Vitamin E + NAC combination

  → Pair with a multivitamin containing zinc and copper

• Omega-3 fatty acids

• B vitamins

  → Especially important if there are methylation issues

  (This is something I am happy to evaluate with targeted labs)

  
  

Botanicals (Herbal Support)

Some patients find meaningful symptom relief with herbal medicine:

• Dong quai

• Echinacea (use this immune support short-term)

• Blue vervain

  → helpful for pain, irregular cycles, and nervous system support

• Dandelion root (liver support)

• Motherwort

  → supports uterine relaxation and pain relief

  
  

The Bigger Picture

Endometriosis is not just a “gynecologic issue.”It’s a whole-body condition involving hormones, inflammation, immunity, and metabolism.

And most importantly:

Your pain is real. Your symptoms matter. And you deserve answers.

If you’ve been told your symptoms are “normal,” or you’re still struggling despite treatment—there are often more layers to explore.

Final Thoughts

There is no perfect treatment—but there is a path forward.

For many women, the best results come from:

• Thoughtful use of hormones (when appropriate)

• Addressing inflammation and immune function

• Supporting estrogen metabolism

• Personalizing care based on your body—not just your labs