Endometriosis living in older adults

Overview

Endometriosis is a condition where tissue similar to the lining of the womb (the endometrium) grows in other parts of the body, most commonly in the pelvic area. This tissue can cause inflammation, pain, and scarring.

Endometriosis affects about 1 in 10 women during their reproductive years. In older adults, it is less common but can still happen, especially if you had it earlier or if you take hormone replacement therapy.

It mainly affects women and people assigned female at birth. It can also affect transgender men who still have their womb and ovaries. In older adults, it is more common in those who have had endometriosis in the past.

Symptoms

Common symptoms

• Pelvic pain
• Painful periods (dysmenorrhea)
• Pain during or after sex
• Pain with bowel movements or urination
• Heavy or irregular bleeding
• Fatigue
• Infertility

Symptoms in children

• Endometriosis is very rare in children before puberty. Symptoms may not appear until after menstruation starts.

Symptoms in older adults

• Chronic pelvic pain that may not be linked to periods
• Pain during intercourse
• Bowel symptoms like pain, bloating, or changes in bowel habits
• Urinary symptoms like pain or frequency
• Fatigue and brain fog
• Bladder pain or pain on urination
• Leg pain

Causes

Main causes

• The exact cause is not known.
• Retrograde menstruation: when menstrual blood flows back into the pelvis instead of out of the body.
• Immune system problems: the body may not clear the tissue that grows outside the womb.
• Genetics: it can run in families.
• Hormones: estrogen encourages the growth of endometriosis tissue.

Risk factors

• Starting menstruation early (before age 11)
• Short menstrual cycles (less than 27 days)
• Heavy or long periods
• Family history of endometriosis
• Having never given birth
• Certain reproductive tract abnormalities

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above
• If pelvic pain is sudden and severe

Book a routine appointment if:

• If you have ongoing pelvic pain or other symptoms that bother you
• If pain during sex or bowel movements is affecting your quality of life
• If you have new symptoms after menopause

Diagnosis

Diagnosis often starts with a discussion of your symptoms and a physical exam. It can also involve imaging tests and sometimes a keyhole surgery called laparoscopy, which is the only way to confirm endometriosis for sure.

Tests that may be done

• Pelvic exam
• Ultrasound scan (to check for cysts or growths)
• MRI scan (to see deeper tissue)
• Laparoscopy (a small camera inserted into the abdomen through a tiny cut)

What to expect at your appointment

Your doctor will ask about your pain patterns, menstrual history, and any other symptoms. You may need to see a gynaecologist (a doctor who specialises in female reproductive health). If you are older, the doctor may also consider other conditions that cause similar symptoms.

Treatment

Treatment focuses on managing pain, reducing the growth of endometriosis tissue, and improving quality of life. The right treatment depends on your symptoms, age, and whether you are taking hormone therapy.

Self-care at home

• Heat packs or warm baths for pain
• Gentle exercise like walking or yoga
• Stress management techniques such as deep breathing or meditation
• Pelvic floor physiotherapy
• Using over-the-counter pain relievers (talk to your doctor first)

Medical treatments

Your doctor may recommend hormone treatments to stop the endometriosis tissue from growing. These can include contraceptives or other medicines that lower estrogen levels. Hormone replacement therapy after menopause may need to be adjusted. Pain medicines and anti-inflammatory drugs can also help. Always discuss options with your doctor, as some treatments may not be suitable for older adults.

When is surgery considered?

Surgery, such as removal of the endometriosis tissue or removal of the womb (hysterectomy), may be considered if other treatments do not work or if symptoms are severe. Hysterectomy is a major decision and is not always a cure. Discuss the risks and benefits with your specialist.

Living with this condition

Living with endometriosis as an older adult means managing pain and other symptoms day by day. Work with your healthcare team to find a routine that helps you stay active and comfortable.

Lifestyle tips

• Get enough rest and listen to your body
• Try gentle stretching or walking to keep muscles flexible
• Avoid activities that trigger pain
• Use relaxation techniques to cope with flares

Diet and exercise

Some people find that eating a balanced diet with plenty of fruits, vegetables, and whole grains helps reduce inflammation. Limiting processed foods and red meat may also help. Staying active with low-impact exercise like walking, swimming, or gentle yoga can improve overall well-being.

Mental health and emotional wellbeing

Living with a chronic condition can be emotionally draining. It is common to feel frustrated, sad, or anxious. Talking to a counsellor or joining a support group can help. If you are having thoughts of harming yourself, please contact your local crisis support line or go to the nearest emergency department.

Prevention

There is no known way to prevent endometriosis. However, early diagnosis and treatment can help prevent symptoms from getting worse.

Complications

If left untreated

• Chronic pelvic pain that does not go away
• Scarring and adhesions (tissue sticking together)
• Ovarian cysts called endometriomas
• Bowel or bladder problems from growths
• Possibly increased risk of certain cancers (rare) – talk to your doctor

Long-term outlook

For most people, endometriosis does not get life-threatening. With the right care, many people can manage their symptoms and have a good quality of life. Even after menopause, symptoms may improve but can still be bothersome. Treatment options are available, and ongoing research continues to improve care.

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