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What is Perimenopause & How Has it Been Linked to Endometriosis?

What is Perimenopause & How Has it Been Linked to Endometriosis?

 Some of the most common symptoms associated with endometriosis include chronic pain, pain during sex and bowel movements, and fatigue. But what about early onset menopause? A new study has concluded that there’s a “statistically significant association” between laparoscopically-confirmed endometriosis and early natural menopause. While the study didn’t consider factors like having surgery to remove cysts from your ovaries (ovarian cystectomies) the findings may have a meaningful impact on patients.  

The symptoms and side effects associated with endometriosis are varying and the World Health Organisation highlights that this may be one of the contributing reasons as to why it can take years for people to obtain a diagnosis from a specialist. However, few studies have linked early natural menopause to the condition. 

Menopause marks one year after your period stops and you can no longer get pregnant. The average age for a person to experience menopause in the United States is 51. However, menopause doesn’t occur overnight. In fact, you may transition into menopause for a decade before your periods stop altogether. This is described as perimenopause. 

During perimenopause, you may experience all of the symptoms associated with menopause alongside the pain and fatigue linked to endometriosis. This experience can be very alarming if you’re unsure of what’s happening or didn’t think you’d start to transition into menopause for another few years. 

What is perimenopause?

As described above, perimenopause is the clinical name given to the period of time when your body is transitioning towards menopause. It literally means “around menopause.” While the terms “premenopausal” and “perimenopausal” are occasionally used interchangeably to describe occurrences around the menstrual cycle, they are two quite distinct phases.  

John Hopkins Medicine outlines that perimenopause can last between two and 10 years and can occur anytime between your 30s and 50s. During this time your ovaries will release eggs less regularly, you’ll produce less estrogen, and you may notice that your menstrual cycles become more irregular. 

This can lead to symptoms that you may most closely associate with menopause. These symptoms can include headaches, severe PMS symptoms, mood changes, irregular periods, muscle tenderness, vaginal dryness, and changes to your libido. 

Amy is 41 years old and lives in New York. She says she started to notice symptoms associated with perimenopause four years ago. She was diagnosed with endometriosis nine years ago. “It started as really dull, persistent headaches and very severe PMS symptoms for me,” Amy says. “After living with chronic pain for 37 years of my life I was more than accustomed to monitoring uncomfortable symptoms.” 

After speaking to her OBGYN, Amy was told she may be starting to transition towards menopause. “I was taken aback,” she says. “I was in my thirties, had been married for a few years, and it just wasn’t something that was remotely on my radar.” 

How has early natural menopause been linked to endometriosis? 

While Amy couldn’t definitively point to her early transition into perimenopause as being associated with her endometriosis diagnosis, new research has suggested that a  “statistically significant association was found between endometriosis and early natural menopause.” 

The study was published in January 2022 on the JAMA Network Open and is one of the only investigations of its kind. Researchers from a range of universities and colleges analyzed the data of 106,633 women between the ages of 25 and 42 who took part in the Nurses’ Health Study II. This was a long-term study where each woman would fill in a survey every two years between 1989 and 2015. They documented any change in health, diagnosis of conditions, and whether they’d transitioned into menopause.

After analyzing the data between October 2020 and April 2021, the researchers concluded that endometriosis may be one important factor contributing to early natural menopause, meaning people who had laparoscopically-confirmed endometriosis may have a shorter reproductive span.  

“We found that women with endometriosis, especially women who never used oral contraceptives or who were nulliparous — a female who has never given birth — may be at risk of a shortened reproductive duration,” said Dr. Madhavi Kulkarni, lead author from the department of obstetrics, gynecology, and reproductive biology at Michigan State University. 

However, the study also acknowledged that more research needs to be done into how perimenopause and endometriosis might be linked, over a longer period of time with a more diverse study group. 

It isn’t the only research to look at endometriosis and menopause 

This is one of the largest studies into how endometriosis and perimenopause may be linked but it isn’t the first time that doctors have sought to examine how perimenopause and menopause may impact patients with endometriosis. 

In 2019, researchers published “Keeping an Eye on Perimenopausal and Postmenopausal Endometriosis” in the Journal of Diseases. By examining the clinical records of perimenopausal and postmenopausal women with endometriosis, they concluded that advanced endometriosis was more prominent in perimenopausal people compared to postmenopausal patients. However, while experiencing endometriosis when you’re postmenopausal is less common, researchers described it as an “important underestimated condition” and doctors should continue providing support for patients. 

Similarly, a study published in the American Journal of Obstetrics and Gynecology suggested that people with endometriosis were at a much higher risk of experiencing early natural menopause. 

Moreover, excision of ovarian endometriotic cysts (endometriomas) is associated with early menopause. For example, menopause occurred earlier when women had cysts in both ovaries compared with only one ovary (42.1 versus 47.1 years of age). The chance of early menopause increased with larger cysts. Surgeons are careful to preserve as much ovary as possible to decrease the risk. And since the research doesn’t compare patients who have had this procedure and patients who haven’t, it’s hard to estimate how many patients with endometriosis developed early menopause.

“Part of me felt silly for not knowing what perimenopause was or when it could begin but no one had ever really spoken to me about it,” says Amy. “Years into my transition and I’ve found a whole community online of people who entered perimenopause in their thirties. This is where I’ve got most of my information and found somewhere to offload.” 

What to do if you start to notice signs of perimenopause

Any changes in your body and mood can be worrying, especially if you’re unsure of what’s causing them. However, as the Cleveland Clinic outlines, there are a number of ways that you may be able to manage your perimenopause symptoms. 

Firstly, if you think you may be transitioning towards menopause then it’s always best to seek medical advice. Speak to your OBGYN about what to expect, any changes you may have noticed, and any discomforts you have. 

If you notice that you’re experiencing low moods, your doctor may be able to refer you to a therapist and/or places of support and community. If your estrogen levels have drastically dipped then you may be able to start taking birth control pills or explore estrogen hormone therapy. 

Over-the-counter vaginal creams may be able to relieve any physical discomfort you have with vaginal dryness and your OBGYN may be able to advise you on ways you can talk to your partner about what you’re experiencing and how they can best support you. 

“I’d spent years of my life in the dark about my health and in pain [with my endometriosis.] It wasn’t something I could go through again,” says Amy. “However, after arming myself with information about what to expect with perimenopause I felt much more in control.”