These women are at a far greater risk of natural and surgical premature and early menopause.
Women with endometriosis are more likely to undergo premature and early menopause than their peers, new Australian research suggests.
The Queensland researchers found that having the condition led to seven times the risk of surgical menopause, which was linked to cardiovascular disease and early death.
“We found surgical menopause occurred, on average, 19 months earlier in women with endometriosis, while natural menopause happened five months earlier,” Dr Hsin-Fang Chung, an epidemiologist from UQ’s School of Public Health, told media.
“Women with endometriosis are twice as likely to experience surgical menopause under the age of 40, or 1.4 times more likely to have natural menopause before 40,’’ Dr Chung said.
Dr Chung and colleagues analysed data from around 280,000 women in Australia, Sweden, the UK and Japan over the last three decades and found that women with endometriosis were 60% less likely to have natural menopause.
They were also twice as likely to experience premature menopause, defined as menopause at age 40 or younger, and 1.4 times more likely to have spontaneous premature ovarian insufficiency (POI).
Dr Chung said she hoped the results would be folded into endometriosis guidelines.
“Our robust evidence on the type and age of menopause may guide updates to endometriosis management guidelines, emphasising prevention and tailored strategies for early or medically induced menopause,” she wrote.
“Long-term monitoring of women with endometriosis is recommended as they are at an elevated risk of surgical menopause and premature ovarian insufficiency or early menopause, as these conditions are associated with adverse health outcomes, particularly CVD and premature death.”
Changes could be made the way endometriosis is managed surgically, which could lower the risk of premature and early surgical menopause, she added.
“Women with endometriosis should be aware that they may be at increased risk of early or induced menopause, visit their GP regularly to check for chronic disease risk factors, and focus on prevention strategies,” she told media.
While MHT was recommended for people with for women with POI until the age of natural menopause to improve health outcomes and survival, Dr Chung and colleagues said that this could be a problem in women with endometriosis.
“MHT, particularly estrogen-only therapy, may have adverse effects, including the potential for disease recurrence and a small but possible risk of malignant transformation,” they wrote.
As a result, guidelines suggested women with POI and endometriosis should have combined estrogen-progestogen therapy, even after a hysterectomy.
“Several plausible mechanisms have been proposed to explain the association between endometriosis and premature or early natural menopause, including reduced ovarian reserve, particularly in women with endometriomas, surgical excision and advantaged stages,” Dr Chung and colleagues wrote.
“Women with endometriosis generally exhibit lower levels of AMH and antral follicle count and elevated levels of follicle-stimulating hormone compared with those without endometriosis or healthy controls.”
Research had also linked the condition with autoimmune disorders such as thyroid disease, Addison’s disease and systemic lupus erythematosus, which the authors said could increase the risk of premature ovarian insufficiency or early menopause.
