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Menopause wasn’t supposed to feel like this—so why does pelvic pain persist when periods stop? We sit down with Dr. Megan Wasson, Chair of Medical and Surgical Gynecology at Mayo Clinic, to confront the enduring myth that menopause—or even ovary removal—automatically ends endometriosis. The short answer: endo is a disease of endometrial‑like tissue, not an ovary problem, and those lesions can produce their own estrogen through aromatase.
Across a focused, fast‑paced conversation, we get clear on what actually drives symptoms after 45, 55, and beyond. Dr. Wasson explains how local estrogen production keeps lesions active, why surgical menopause often leads to new risks without solving pain, and what a modern care plan should look like when cycles fade but symptoms don’t. We explore smarter hormone therapy for hot flashes, sleep issues, and brain fog—when combined estrogen and progesterone makes sense, when estrogen‑only can be safe, and how to avoid common pitfalls with testosterone supplementation that can inadvertently fuel endo.
You’ll hear practical guidance on assessing disease burden, deciding if and when excision is warranted, and building a supportive team that addresses pelvic floor dysfunction, pain processing, and long‑term health. The goal is clarity: understand the biology, personalize hormone choices, and focus on the lesions—not just the labs. If you’ve felt dismissed or confused about treatment after menopause, this conversation brings both validation and a roadmap.
If this helped you rethink endometriosis after menopause, follow the show, share it with someone who needs it, and leave a quick review so others can find these expert insights. Got a question for our next Quick Connect? Send it in—we’re listening.
Website endobattery.com
Episode Transcript
Endometriosis doesn't care how old you are.
(00:02):
Maybe you're in menopausethinking, wait, why am I still
in pain?
In this episode, Dr.
Megan Wasson, Chair of Medicaland Surgical Gynecology at the
Mayo Clinic, walks us throughwhat endo can look like, not
just in your reproductive years,but beyond.
Yes, we even go there.
Endo after menopause.
Dr.
Wasson brings clarity, passion,and real insight into the care
(00:25):
we all deserve.
So grab your favorite drink,take a deep breath, and join us
because you are not alone inthis fight.
Life moves fast, and so shouldthe answers to your biggest
questions.
Welcome to Indo Batteries QuickConnect, your direct line to
expert insights.
Short, powerful, and right tothe point.
You send in the questions, Ibring in the experts, and in
(00:47):
just five minutes, you get theknowledge you need.
No long episodes, no extra timeneeded.
And just remember, expertopinions shared here are for
general information and not forpersonalized medical advice.
Always consult your provider foryour case-specific guidance.
Got a question?
Send it in, and let's quicklyget you the answers.
I'm your host, Alana, and it'stime to connect.
(01:14):
Today's guest is someone whobrings a deep expertise,
compassion, and innovation tothe field of gynecology.
Dr.
Megan Wasson is the chair of theDepartment of Medical and
Surgical Gynecology at the MayoClinic in Arizona and a
professor of obstetrics andgynecology at the Mayo Clinic
College of Medicine and Science.
Her clinical focus includesendometriosis, chronic pelvic
(01:36):
pain, and advanced surgicaltechniques.
Dr.
Wasson is helping redefine whatcare can look like for patients
around the world.
Please help me in welcoming Dr.
Megan Wasson.
Let's talk about the myth ofmenopause cures endometriosis.
Why isn't that always true?
SPEAKER_01 (01:52):
Or so number one, um, one of my biggest pet peeves
with endometriosis in general iswhen individuals have their
uterus removed, their ovariesremoved, and nothing is done for
endometriosis, but I cured yourendometriosis.
Nothing could be further fromthe truth.
So endometriosis, yes, itresponds to the hormones that
(02:13):
the ovaries release, but it'snot an issue with the ovaries.
It's an issue with how thattissue is responding.
So we need to focus on fixingthat tissue rather than just
castrating everyone and removingovaries.
So I very, very rarely amremoving ovaries for treatment
of pelvic pain for treatment ofendometriosis.
(02:33):
And the reason for that is if wereally understand endometriosis,
it truly is endometrial-liketissue.
It is not the endometrium.
So endometriosis has a chemicalin it called aromatase, and
aromatase converts testosteroneinto estrogen.
So even if the ovaries are gone,the endometriosis is going to
(02:54):
continue to feed itself.
And so whether that's surgicalmenopause, natural menopause,
medical menopause, using thosevarious medications that I
previously mentioned, symptomscan continue.
Symptoms can't progress.
And we shouldn't just ignorethem and say, well, I guess
you're menopausal and there'snothing else we can do.
So now you really have to justsuck it up and deal with.
SPEAKER_00 (03:17):
I think there's a lot of fear as well when you get
into this stage and you want todo hormone replacement therapy.
And I think that a lot of peopleare leery of doing that because
they have endometriosis and theydon't want to make it worse.
Can you touch on that just alittle bit?
Because I think that is a fearof a lot of these people walking
through the stage of life.
SPEAKER_01 (03:36):
Yeah, and that's where you really need to
understand how these hormonesinterplay and what affects
endometriosis.
I recently just saw a patient,she came in, was getting
testosterone supplementation,and was completely asymptomatic.
Endometriosis had never evenentered the conversation until
she was getting thattestosterone, and all of a
sudden she developed severepelvic pain and no one could
(03:57):
understand why.
Well, endometriosis convertsthat testosterone into estrogen.
And so it just caused thatvicious cycle to really ramp up.
So that being said, hormonereplacement therapy is not the
enemy.
We just need to be very mindfuland very cognizant about what
we're doing with hormonereplacement therapy and
balancing those risks andbenefits.
(04:18):
So just another plug for whyremoving the ovaries doesn't
really make sense.
So if you have someone who isvery young and you remove the
ovaries, you induce menopause,the immediate next thing is
going to be, well, now you're atrisk for osteoporosis, heart
disease.
I need to give you hormones nowto reduce that risk.
So we've taken the hormonesaway, but now I'm gonna give you
(04:38):
hormones because you need thehormones in your body.
It just doesn't logically lineup.
Right.
So that's another point for whywe just really shouldn't be
doing that.
But after menopause, in thatperimenopausal transition,
there's a lot of other symptomsthat can arise.
Hot flashes, difficultysleeping, that brain fog is very
(05:00):
common and hormones can helpwith that.
And so if you need hormones tohelp to support your body during
that transition, absolutely wecan do that.
If someone still has a largeamount of disease burden with
endometriosis, so that patientwho we've been following with
endometriomas hasn't wanted todo surgery, I do recommend
estrogen and progesteronetogether in that patient, even
(05:22):
if they've had a hysterectomy.
So for some individuals, afterhysterectomy, we say only
estrogen, you don't need anyprogesterone.
But on the flip side of that, ifit's someone who's had a very
thorough excision ofendometriosis or not suspicious
of significant disease burdenremaining, that's where someone
can use estrogen alone, andthat's completely fine.
If they need estrogen to helpwith those menopausal symptoms,
(05:45):
absolutely endometriosis is nota contraindication to hormone
replacement therapy.
SPEAKER_00 (05:50):
That's a wrap for this quick connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming.
Send them in, and I'll bring youthe expert answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at indobattery.com or visitingthe Indobattery.com contact
(06:15):
page.
Until next time, keep feelingempowered through knowledge.
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