For years, many people living with endometriosis are told the same thing: “It will all settle down after the menopause.” For some, symptoms do ease. For others, pain carries on, changes shape, or appears for the first time in midlife. And for many more, it becomes hard to tell which pain belongs to endometriosis, which belongs to the menopause, and which is something else entirely.

This year the International Menopause Society has chosen Chronic Pain in Midlife as the theme for World Menopause Day [1]. It is a theme our community knows well, so we want to use it to talk honestly about what midlife can look like when you are already living with a chronic condition.

Endometriosis is a full-body, systemic inflammatory condition. It affects the reproductive system, but it is not confined to it, and it does not simply stop when periods do.

One reason is that endometriosis lesions can make their own oestrogen. Research has found that endometriosis tissue contains aromatase, the enzyme that produces oestrogen, which allows lesions to sustain themselves even when the ovaries are producing very little [2][3]. Reviews estimate that around 2 to 5 percent of postmenopausal women have endometriosis [4][5], and because the condition has historically been studied in younger people, the true figure is likely to be underestimated [3].

It is also worth knowing that, both before and after menopause, how much pain someone reports does not always reflect how extensive the disease is [4]. Pain in midlife deserves the same proper investigation it deserves at any other age.

Midlife brings its own pain. A 2024 review in Climacteric, the journal of the International Menopause Society, estimated that more than 70 % of women experience muscle and joint symptoms through the menopause transition, and around 1 in 4 find them disabling [6]. The authors proposed a new name for this cluster: the musculoskeletal syndrome of menopause.

For someone with endometriosis, this creates a real problem. Fatigue, joint pain, bloating, low mood and poor sleep can all come from endometriosis, from the menopause, or from both. When symptoms overlap, it is easy for one to be blamed on the other, and for nothing to be properly looked at. If your pain has changed, worsened or moved, that is worth raising rather than putting down to “just your age.”

Many people with endometriosis worry about whether hormone replacement therapy (HRT) is safe for them. HRT can be an option, but the type matters. Research has linked some forms, particularly oestrogen-only HRT after a hysterectomy, with endometriosis becoming active again [3]. This is something to talk through with a clinician who understands endometriosis, so you can weigh up menopause symptom relief against your own history.

The same applies if you have had, or are considering, surgery that brings on menopause. Ask what to expect afterwards and what support will be in place.

Keep a symptom diary. Without periods to anchor it, pain can feel random. Recording when it happens, where it is and what else is going on helps you and your clinician spot patterns.

Ask directly whether endometriosis could still be involved. A previous diagnosis, or years of unexplained pain, is important history to share, especially if your clinician is new to you.

Ask about HRT with your endometriosis history in mind. Go in with your questions written down, including what type of HRT is being suggested and why.

Keep moving where you can. Muscle and joint health matter more in midlife, and gentle, regular movement is often recommended for menopause-related joint pain. A physiotherapist can help you find what is manageable alongside endometriosis.

Look after your mental health too. Long-term pain and hormonal change can both affect mood and sleep. Asking for psychological support is part of managing a chronic condition, not separate from it.

If you were told your pain would end at menopause and it hasn’t, you have not done anything wrong. Endometriosis is a lifelong, whole-body condition, and midlife pain is just as worthy of attention as pain at 15 or 30. Whatever stage of life you are at, you deserve to be listened to, investigated properly and supported.