Detailed definition
Endometriosis is the presence of endometrial-like glands and stroma outside the uterine cavity, most commonly in the pelvic peritoneum, ovaries (endometriomas), and rectovaginal septum. It affects roughly 10% of reproductive-age women and produces dysmenorrhea, chronic pelvic pain, dyspareunia, and infertility. Endometriosis lesions are estrogen-dependent — they grow under estrogen stimulation and regress under hypoestrogenic conditions. Treatment options include combined hormonal contraception, progestins, GnRH agonists/antagonists with add-back therapy, and surgical resection. After menopause, endometriosis typically becomes quiescent. However, some postmenopausal women have persistent or even malignant transformation of endometriosis lesions, and starting HRT can occasionally reactivate symptoms. For women with significant prior endometriosis on HRT, combination therapy (estrogen plus progestogen, even after hysterectomy) is sometimes preferred to reduce recurrence risk.
Why it matters in menopause
Endometriosis history matters at HRT initiation. For most women, postmenopausal endometriosis is quiescent and standard HRT is fine. For women with extensive prior disease, combined therapy and clinical monitoring make sense.