Endometriosis and the Accelerated Path to Menopause

Not just “painful periods.” It is a chronic, debilitating disease where cells lining the uterus (endometrium) are found where they should not belong. Endometriosis poses many threats to health, and notably has a direct link to the premature onset of menopause. This was confirmed by a large-scale 2025 study involving nearly 280,000 women, which found an increased risk of both natural and surgical early menopause.

Endometriosis – The Price of a Chronic Process

According to WHO estimates, endometriosis affects approximately 10% of women of reproductive age worldwide—over 190 million. Yet, the path to diagnosis takes an average of 7 to 10 years. Women with endometriosis can suffer for years from severe pain, digestive issues, chronic fatigue, and infertility. The causes of the disease are still undetermined, and classic treatment carries its own risks—read more about endometriosis in our Encyclopedia.

The topic of endometriosis is one of the most pressing in gynecology today, as it is associated not only with increased awareness but also with the growing number of women and adolescent girls with this diagnosis.

It is worth reminding that gynecological disorders impact the entire body, especially a critically important resource: the ovarian reserve. Researchers emphasize that in recent years, the onset of the menopausal transition (perimenopause) has significantly “aged down.” In the presence of endometriosis, the risk of premature exhaustion of reproductive function increases even further.

Essentially, this is a hormonal deficit in a young body, associated with all the challenges of menopause: an increased risk of cardiovascular disease, osteoporosis, depression, and cognitive function loss.

What the Sample of Over a Quarter Million Women Revealed

A large-scale study involving 279,948 women was published in the prestigious journal Human Reproduction in 2025. The goal was to determine: is endometriosis truly linked to premature menopause?

It turned out – yes. Women with endometriosis had a higher risk of both premature natural and surgical menopause (when the ovaries are removed). And even after accounting for other factors—age, weight, smoking, race, education, fertility, etc.—the association remained significant.

The reason, researchers believe, lies in the chronic inflammation and immune dysregulation characteristic of endometriosis. This can lead to the depletion of the follicular reserve, meaning the “exhaustion” of the ovaries significantly earlier than the natural term.

The Double Blow: Surgical and Medication Factors

The conclusion regarding the increased risk of surgical menopause confirms a previously known medical fact: endometriosis treatment often carries risks for the ovarian reserve itself.

1. Direct loss due to surgery. When endometriosis forms cysts (endometriomas) on the ovaries, surgical intervention may be required. It is important to remember that any intervention on the ovaries always means a loss of ovarian reserve. This increases the probability of a woman transitioning into the category of patients with premature ovarian dysfunction after the operation.

2. Medication-induced menopause. Drugs from the group of GnRH agonists and antagonists (gonadotropin-releasing hormone) or gonadorelin are used for treating endometriosis. This hormone is produced by the hypothalamus and stimulates the anterior pituitary gland to release gonadotropins, specifically follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which regulate the function of the gonads. These drugs essentially induce menopause in a woman by suppressing ovarian function. Although effective against endometriosis, such medications have side effects typical of natural menopause:

Bone loss, potentially leading to osteopenia and osteoporosis;
Vasomotor symptoms (hot flashes);
Genitourinary Syndrome, which includes urination difficulties, impaired mucosal quality in the intimate area, and decreased libido.

These medications have a strict limitation—they should not be taken for more than six months.

The issue of early reproductive aging has systemic consequences. Canadian and British scientists found that multiple perimenopause symptoms are associated with an increased risk of cognitive disorders and a decline in cognitive functions. Thus, an early or aggressively induced drop in estrogen levels caused by endometriosis and its treatment also impacts brain health.

Endometriosis and Menopause: Knowledge for Prevention

Timely diagnosis and early initiation of treatment significantly increase the chances of inducing remission. The goal is to make endometriosis inactive and reduce the risk of needing surgical intervention.

If endometriosis requires active intervention, knowledge is the primary tool for quality communication with the physician:

Ovarian Reserve Assessment. Before undergoing ovarian surgery, it is critically important to count antral follicles and measure Anti-Müllerian Hormone (AMH). This allows the physician and patient to understand the chances of transitioning into the category of women with premature ovarian dysfunction.
Bone Density Check. If menopause-inducing drugs (such as GnRH agonists) are prescribed, women over 35 are recommended to undergo densitometry. If there are already signs of osteopenia or osteoporosis, this type of medication is not recommended.

The acceleration of menopause due to endometriosis can be compared to a situation where a fire (chronic inflammation) breaks out in a treasury. Aggressive treatment is a necessary “evacuation” of the valuable resource (follicles), which, while saving the core system, significantly reduces the total stock of “gold” (ovarian reserve) needed for the long-term functioning of the system.

The sooner you consult a specialist, the better the chances of success and preservation of your reproductive health.

Where to Seek Help

Experienced gynecologists specializing in endometriosis work at the Lior Medical Center. Here, you can undergo examinations, ultrasound diagnostics, tests, and receive a treatment plan individually tailored to your age, disease stage, and future plans.

Do not postpone your visit—sometimes this means preserving fertility, hormones, and peace of mind for many more years. You can find details and book an appointment by calling +380 73 200 6198 or via this number on Telegram.