Medically induced menopause after treatment for endometriosis or adenomyosis

Making decisions about treatment for endometriosis or adenomyosis can feel overwhelming, especially when treatments can cause side effects such as medically induced menopause. It’s natural to feel uncertain or worried about how this might affect your body, emotions or future health.

At just 23, Arelene had a full hysterectomy with removal of both ovaries after endometriosis was found across all her organs. It was a difficult, life-changing decision, and she went straight into surgical menopause.

“It was the best decision I made, as I was always off school or work,” she says. “I want others to know they’re not alone.”

This information explains what medically induced menopause is, why it may happen and what decisions you may face. It’s designed to help you feel informed and supported as you make choices about your care.

What is medically induced menopause?

Menopause is when your periods stop because the ovaries no longer release eggs and stop producing the hormones oestrogen and progesterone. It usually happens between ages 45 and 55.

Medically induced menopause happens when menopause occurs because of medical treatment rather than naturally. This can happen suddenly, and symptoms are similar to natural menopause but often start suddenly and may feel more intense.

See Jean Hailes for Women’s Health for more information on medically induced menopause.

Why medically induced menopause happens

To manage endometriosis or adenomyosis, your doctor may suggest treatments to lower or stop the body’s production of the hormone oestrogen, which makes endometriosis tissue grow.

These treatments may include:

• Hormone medicines called gonadotrophin-releasing hormone (GnRH) analogues which temporarily stop the ovaries from making the hormones oestrogen and progesterone

• Surgery that removes both ovaries (bilateral oophorectomy) which causes immediate and permanent menopause. If the uterus is removed but the ovaries remain, menopause does not occur immediately but may happen earlier than average. Oestrogen can help shrink endometriosis, and reduce inflammation, pelvic pain and heavy bleeding.

What are the symptoms of medically induced menopause

Symptoms are similar to natural menopause but often start suddenly and may feel more intense. Common symptoms include:

• hot flushes and night sweats
• trouble sleeping
• feeling more anxious, low or irritable
• dry or tight vagina
• low interest in sex (low libido).

For more information about menopausal symptoms, managing medically induced menopause and symptom relief, visit jeanhailes.org.au

Weighing up the choices

Understanding the possible benefits and drawbacks of treatments that may induce menopause can help you make the decisions that feel right for you.

Option	Benefits	Drawbacks
If you have treatment that may cause medically induced menopause	Pain and heavy bleeding may ease or stop. Daily life may feel easier with fewer disruptions. Some hormone treatments are temporary – periods and fertility may return when you stop. Surgery can provide long‑term relief if other treatments haven't worked. Managing symptoms early may help protect your overall wellbeing.	Menopause symptoms can start quickly and feel more intense than natural menopause. Fertility may be reduced while taking medicines or be permanent if ovaries are removed. Lower oestrogen can affect bone and heart health. You may have emotional challenges such as feeling older than your age or different from your friends. Sexual activity may be affected because of vaginal dryness, discomfort or low libido. Some treatments need regular follow‑up or ongoing care.
If you choose not to have treatment that causes medically induced menopause	You may avoid sudden or more intense menopause symptoms. Fertility may be preserved for longer. You avoid the long‑term health risks linked to early menopause. You won't need to manage the emotional impact of early menopause. You may feel you have more in common with people who go through menopause naturally.	Pain, heavy bleeding or other symptoms may continue or worsen. Ongoing symptoms may disrupt daily life. Endometriosis may still affect fertility. You may need repeated medical care or emergency treatment if symptoms flare. Ongoing pain or uncertainty can affect your emotional wellbeing.

Key factors to consider

If your doctor suggests treatments that could bring on medically induced menopause, it can help to discuss the factors that may influence your decision:

• Your age and stage of life – Menopause at a younger age can have different effects on fertility, bones and heart health.

• Symptoms and their impact – Endometriosis or adenomyosis can occur in different areas and affect daily life in different ways. Treatments that induce menopause may offer relief, but how much relief you need depends on how your symptoms impact you.

• Your treatment history – If you’ve already tried medicines, hormone therapy, or surgery, it’s helpful to discuss what has or hasn’t worked. This can guide whether treatments that bring on menopause are the best next step.

• Your goals and priorities – Do you want to focus on symptom relief, preserving fertility, or protecting long-term health? Different treatments may affect these goals differently. Sharing your priorities helps your health care team tailor recommendations to what matters most to you.

• Benefits and risks – Discuss the benefits and drawbacks so you weigh up what matters most to you.

Thinking about these points can make it easier to ask questions and make decisions that feel right for you.

Fertility considerations

If you want to have children in the future, talk to your doctor about fertility options such as egg freezing before treatment. They can talk with you about options such as egg freezing or delaying certain treatments.

Questions to ask your doctor

Talking to your doctor about your options can help you make informed decisions. Some useful questions include:

• Why are GnRH drugs or surgery recommended for me?

• What are the short- and long-term risks of medically induced menopause for me?

• Is MHT or add-back therapy suitable for me?

• How will this affect my fertility, sexual health and emotional wellbeing?

• What can I do to protect my bones and heart?

• What are my options for managing menopausal symptoms?

• What tests or scans do I need?

• Will my menopause symptoms go away after treatment?

• What support services are available where I live?

• Are there other treatment options for me?

• If I don’t have a surgery or hormone treatments, what can I expect?

Endometriosis after menopause

For many people, endometriosis symptoms ease after menopause. But sometimes, endometriosis can continue or even appear after menopause. Using MHT may increase the risk of symptoms returning.

Endometriosis after menopause is uncommon. In rare cases it may be associated with certain ovarian cancers, so ongoing symptoms should be discussed with your doctor.