Endometriosis May Double Risk of Premature Menopause
Women with endometriosis are at a higher risk of early or surgical menopause, with impacts on their long-term health.
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Women with endometriosis are at a higher risk of experiencing menopause earlier, particularly if their menopause was brought on by surgery, according to new research from the University of Queensland.
Published in Human Reproduction, the study looked at long-term data from hundreds of thousands of women across four countries to examine how endometriosis affects the timing and type of menopause.
Endometriosis may affect menopause timing
Endometriosis is a long-term condition where tissue similar to the lining of the uterus grows elsewhere in the body. It affects ~1 in 10 women of reproductive age. The symptoms vary but often include pelvic pain and fertility problems. It can also reduce the number and quality of eggs in the ovaries, but its effects beyond fertility have been harder to pin down. One area that has had few data is menopause.
Menopause marks the end of ovarian function. When it happens early – before 45 – it raises the risk of several health issues, including cardiovascular disease, osteoporosis and early death. If menopause occurs because both ovaries have been removed as part of surgery, those risks can be higher.
“Evidence on its [endometriosis] relationship with the type of menopause (surgical vs natural) and timing (especially premature and early menopause) is limited,” said the authors.
Smaller studies have hinted that women with endometriosis may reach menopause earlier, especially if they’ve had surgery for the condition. But most of this research has focused on fertility, not menopause. There has been no large-scale study comparing natural and surgical menopause outcomes in women with and without endometriosis across different populations.
“Women with endometriosis are more likely to undergo hysterectomy and/or oophorectomy (either unilateral or bilateral), but the average age of these surgeries remains unclear,” said the authors.
“Preventing or managing early or medically induced menopause requires a comprehensive understanding of its underlying causes and proactive measures to address the long-term health risks associated with it,’’ said corresponding author Dr. Gita Mishra, a professor and founding director of the Australian Women's and Girls' Health Research Centre at the University of Queensland.
Using data from nearly 280,000 women in Australia, the UK, Sweden and Japan, Mishra and their team set out to see whether endometriosis is linked to the timing and type of menopause.
Endometriosis raises menopause risk
The study is part of the InterLACE project, a long-running collaboration focused on women’s reproductive health. The team looked at data collected between 1996 and 2022.
They classified menopause as either natural (when periods stop for 12 months) or surgical. Endometriosis was identified through self-report and linked health records. Menopause age was analyzed both as a continuous measure and in defined age brackets: Premature (under 40), early (40–44) and average or later (45 and over). They adjusted for a range of factors that could affect results, including body mass index, smoking, education and age at first period.
Among the women studied, 3.7% had endometriosis. Their likelihood of undergoing surgical menopause was seven times higher than those without the condition.
“We found surgical menopause occurred, on average, 19 months earlier in women with endometriosis, while natural menopause happened 5 months earlier,” said lead author Dr. Hsin-Fang Chung, a research fellow in the School of Public Health at the University of Queensland.
Among those who had surgical menopause, women with endometriosis were more than twice as likely to have it before age 40. For natural menopause, they were 36% more likely to experience it prematurely.
Women with endometriosis were also significantly more likely to experience early menopause between the ages of 40 and 44 years, whether naturally or surgically.
These associations remained even after accounting for infertility and the number of children, which are known to affect menopause timing.
Despite differences in population and data collection, similar patterns were observed across all five international cohorts.
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Implications for women’s long-term health
The findings point to a need for earlier, tailored reproductive health advice for women with endometriosis. Understanding that there is a higher risk of early or surgical menopause allows for better planning, whether that means earlier fertility discussions, regular check-ups or decisions about surgery.
“Women with endometriosis should be aware that they may be at increased risk of early or induced menopause, visit their GP regularly to check for chronic disease risk factors and focus on prevention strategies,” said Chung.
The size and scope of this study make it the most extensive analysis of its kind, drawing on consistent data from several countries. However, the study couldn’t look at how different types or stages of endometriosis affect menopause, or at how specific treatments, like surgery to remove ovarian cysts, might influence the results.
“Future studies incorporating data on the subtype, stage and treatment of endometriosis are needed to better understand the biological mechanisms and evolutionary origins of the condition,” said the authors.
Studies that track treatment history and disease severity could also help clarify who’s most at risk.
Reference: Chung HF, Hayashi K, Dobson AJ, et al. Association between endometriosis and type and age of menopause: a pooled analysis of 279 948 women from five cohort studies. Hum Reprod. 2025:deaf068. doi: 10.1093/humrep/deaf068
This article is a rework of a press release issued by the University of Queensland. Material has been edited for length and content.
