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People with endometriosis are seven times more likely to undergo surgical menopause and face an increased risk of premature menopause before the age of 40, either naturally or through surgery, than those without endometriosis.
Endometriosis is a chronic, oestrogen-dependent condition where tissue similar to the uterine lining grows outside the uterus, leading to inflammation, pain and scarring. The World Health Organization estimates that approximately 10% of women and girls of reproductive age (around 190 million individuals worldwide) are affected by the condition. In Australia, one in seven women are diagnosed with endometriosis by the age of 50, with higher rates observed among younger generations. These generational differences may reflect growing awareness among the general public and health professionals, leading to earlier recognition and higher diagnosis rates in more recent birth cohorts.
Recognising the significant impact of endometriosis, Australia was the first country to introduce a National Action Plan for Endometriosis in 2018. The plan aimed to raise awareness, improve clinical management and care, and support research. As part of this initiative, Australia developed its first Australian Living Evidence Guideline: Endometriosis in 2022, offering a standardised, evidence-based approach to diagnosis and treatment.
Treatment typically focuses on managing pain and slowing the progression of the disease. Some patients undergo multiple surgeries to relieve symptoms, including the removal of endometrial lesions or, in severe cases, the uterus and both ovaries. Women with endometriosis often exhibit reduced ovarian reserve, as indicated by lower levels of anti-Müllerian hormone, reduced follicle counts, and elevated follicle-stimulating hormone levels, compared to women without endometriosis, which can lead to infertility. Both the disease itself and surgical treatment can further diminish ovarian reserve and result in early menopause in young women.
Our research has confirmed that women with endometriosis have an increased risk of premature and early menopause, either naturally or surgically. This is an international study, led by the Australian Women and Girls’ Health Research Centre at the University of Queensland, that analysed data from nearly 280 000 women across five cohort studies in Australia, the United Kingdom, Sweden and Japan to investigate the link between endometriosis and the type and timing of menopause.
What did we find?
Women with endometriosis were seven times more likely to undergo surgical menopause (removal of both ovaries) before the natural onset of menopause, on average, occurring 19 months earlier than those without endometriosis. For women who experienced natural menopause, it occurred five months earlier.
The risk of undergoing premature surgical menopause before the age of 40 was double in women with endometriosis (20.0%) compared to those without (11.8%).
Premature natural menopause before the age of 40 (known as spontaneous premature ovarian insufficiency) occurred in 2.0% of women with endometriosis compared to 1.6% in women without the condition, representing a 40% increased risk.
Women with endometriosis were also more likely to experience early menopause between 40 and 44 years, both naturally and surgically.
All results were adjusted for birth year, race, education level, smoking status, body mass index and age at first menstruation. Women who had a hysterectomy with ovarian preservation (one or both ovaries intact) were excluded to ensure accuracy in assessing menopause age.
What do these findings mean?
This is the largest and most comprehensive study to examine the type and timing of menopause among women with endometriosis. It underscores the importance of raising awareness among patients and clinicians about the potential risk for premature and early menopause, particularly because of the removal of both ovaries.
Early or surgical menopause is known to be associated with the risk of chronic diseases in later life, including cardiovascular disease (here and here) and osteoporosis, partly due to the early loss of oestrogen.
We know women living with endometriosis may already have a difficult journey, including delayed diagnosis, chronic pain and fertility concerns. These findings are not intended to cause further concerns, but to empower women and their health care providers to plan for long term health monitoring and care.
GPs and other health professionals should be aware of the increased risk of premature and early natural menopause in patients with endometriosis and take steps to delay or avoid surgical menopause where possible. Proactive mentoring, regular check-ups to assess and manage chronic disease risk factors, and patient education on maintaining a healthy lifestyle are essential components of long term care.
A need for long term management guidelines
Current clinical guidelines for endometriosis focus on pain, infertility, and medical and surgical treatment options. Only the ESHRE guidelines briefly touch on menopause in the context of treating endometriosis in post-menopausal women and managing menopausal symptoms in women with a history of endometriosis. There remains a lack of guidance on managing long term health risks associated with early or surgical menopause in women with endometriosis.
This research highlights the need for future guidelines to address the risk of chronic diseases linked to early or surgical menopause and long term health monitoring and care for women with endometriosis.
There has been a call for a second National Action Plan for Endometriosis, aimed at helping improve care and the quality of life for women with this condition.
These findings will be presented at the 16th World Congress on Endometriosis in Sydney in May 2025, a global conference bringing together clinicians, researchers and allied health professionals dedicated to advancing endometriosis care.
Dr Hsin-Fang Chung is a National Endometriosis Clinical and Scientific Trials (NECST) Fellow and Research Fellow at the Australian Women and Girls’ Health Research Centre at the University of Queensland.
Professor Gita Mishra is aNational Health and Medical Research Council Leadership Fellow and Director of the Australian Women and Girls’ Health Research Centre at the University of Queensland.
The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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