Endometriosis and HRT (fact sheet)

What is endometriosis?

Endometriosis a common condition where cells like the ones in the lining of your womb (uterus) are found elsewhere in your body, such as your ovaries and fallopian tubes, your bowel and your bladder. Endometriosis can cause heavy painful periods, pain in your abdomen and pelvis and for some women problems with infertility. Around one in ten women have endometriosis.

However, with the right endometriosis treatment, many of these issues can be addressed, and the symptoms of endometriosis made more manageable.

Treatment for endometriosis

Treatment of endometriosis can be very effective and can really improve any symptoms. Treatment usually involves limiting or stopping the production of the hormone oestrogen. This is because oestrogen can encourage endometriosis tissue to grow. 

There are various treatments available such as the combined oral contraceptive pill, the Mirena coil and painkillers. Some women need an operation to control their symptoms. For some women this can result in a hysterectomy (removal of your womb). Some women also have their ovaries removed. Although these operations often are successful in improving endometriosis symptoms they can lead to a surgical menopause occurring. 

This can lead to a sudden onset of menopausal symptoms which can be severe and disabling, having a negative impact on the quality of your life. Having the right type and dose of HRT can often really improve these symptoms. 

Benefits of HRT

It is really important that women with endometriosis receive individualised care and advice about hormone treatment, ideally from a doctor who specialises in the menopause. Taking HRT usually improves menopausal symptoms such as hot flushes, night sweats, low mood, anxiety, headaches, urinary symptoms and reduced libido. In addition, research has clearly shown that women taking HRT will have a lower future risk of heart disease and osteoporosis. 

If you have had an early surgical menopause (under the age of 45 years) it is very important that you receive hormones as without HRT or the contraceptive pill then you have a greater risk of developing heart disease, stroke, osteoporosis and diabetes without oestrogen. 

For the majority of women, the benefits of HRT outweigh any risks.

Risks of HRT

The majority of women with endometriosis do not have any problems with taking HRT and they experience no recurrence in their symptoms. 

Currently there is a lack of high-quality research looking into the risks of HRT in women with endometriosis. There is a possibility that oestrogen can re-activate endometriosis giving rise to symptoms of endometriosis occurring in a small number of women. 

Types of HRT

Many women who are thought to have some endometriosis remaining after a hysterectomy are given a progestogen with oestrogen to reduce the risk of any endometriosis tissue being stimulated by the oestrogen. All women who have a womb need to have a progestogen. Women with endometriosis are usually given a progestogen daily which helps to reduce any symptoms and changes of endometriosis recurring.

Women who have had endometriosis and a hysterectomy can take oestrogen only HRT if their surgeon is confident that all the endometriosis tissue has been removed.

If HRT is being taken as an “add back” to a medication such as Zoladex, then it is usually given as a small dose to help to counteract any menopausal symptoms that can occur due to the medication. 

However, very occasionally endometriosis can re-activate spontaneously without taking any oestrogen. It is therefore important for women to report any recurrence of endometriosis symptoms such as pelvic pain, or bleeding from the vagina bladder or bowel. 

Last Updated: March 2019

Print this article

Share this article