Gynae

Endometriosis

Creator: Dr Nadira Awal
Published: 2026-01-15

How endometriosis behaves during perimenopause and postmenopause.

By Dr Nadira AwalBMS Specialist2 min readMedically reviewed 9 July 2026

Single deep red peony bud on a folded linen napkin

Endometriosis doesn't always end at menopause, and HRT choices need to be made carefully. This guide explains how to balance symptom relief with disease control.

Endometriosis doesn't automatically end at menopause, and how HRT is chosen matters. The aim is to treat menopausal symptoms without reactivating disease.

Why endometriosis complicates HRT choices

Unopposed oestrogen can reactivate residual endometrial tissue.
Continuous combined HRT — with continuous progestogen — is usually preferred to cyclical.

Considerations after hysterectomy for endometriosis

A progestogen is often still added for 3–6 months post-op to suppress any residual tissue.
This is different from standard post-hysterectomy HRT where oestrogen alone is used.

What to raise in your consultation

Age at diagnosis and extent of disease.
Whether ovaries were preserved.
History of bowel or bladder involvement — these can flare with poorly chosen HRT.

Ongoing care

Any new pelvic pain or bleeding on HRT needs prompt review.
Working alongside your gynaecologist is often ideal.

How Dr Awal approaches this in clinic

Every consultation starts with your full story — symptoms, cycle, medical history, family history and what you've already tried. From there we look at whether hormonal treatment, non-hormonal options, lifestyle changes or a combination will give you the best result, and we tailor the plan to your age, risk factors and preferences.

A detailed 60 minute first appointment — no rushed 10-minute slots.
Evidence-based recommendations aligned with NICE NG23 and BMS guidance.
Body-identical HRT considered first-line where appropriate.
Shared-care letters sent to your NHS GP so treatment can continue affordably.
Follow-up at 3 months to fine-tune your regimen and address side effects.
Ongoing annual reviews so your plan evolves with you.

Common questions we hear about this

Do I need to be at a certain age to be seen?

No. We see women in early perimenopause (often late 30s and 40s), through post-menopause and beyond. Age alone doesn't decide whether treatment is right — symptoms, health history and goals do.

Will my GP continue the prescription?

In most cases yes. After your consultation we send a detailed shared-care letter with the diagnosis, treatment plan and rationale so your NHS GP can prescribe on the NHS. Not every practice accepts shared care — we'll discuss this in your appointment.

What if I've tried HRT before and it didn't suit me?

Very common — often the type, dose or route wasn't right rather than HRT itself. We review what you've tried, why it didn't work, and adjust accordingly. Many women who thought HRT wasn't for them do well on a different preparation.

How long will I need to stay on treatment?

There is no set upper time limit for HRT. Current BMS and NICE guidance supports continuing HRT for as long as the benefits outweigh the risks for you personally. We review this together every year so you stay in control of the decision.

Where do you see patients?

All consultations at Pause and Co Healthcare are conducted securely via video, allowing us to support patients anywhere in the UK. Prescriptions and shared care arrangements are managed in the same way, regardless of your location.

About the author

Dr Nadira Awal is a British Menopause Society Advanced Menopause Specialist with 15+ years' NHS and private experience. She holds the BMS Advanced Certificate in Menopause Care, sits on the BMS Programme Planning Group, and advises the UK Government Menopause Strategy Group. Read her full profile.

Sources & further reading

General information only — not a substitute for personalised medical advice. Always speak to your GP or a menopause specialist about your own situation.

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