Endometriosis doesn't care how old you are.

Maybe you're in menopause thinking, wait, why am I still in pain?

In this episode, Dr.

Megan Wasson, Chair of Medical and Surgical Gynecology at the Mayo Clinic, walks us through what 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 we all deserve.

So grab your favorite drink, take a deep breath, and join us because you are not alone in this fight.

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I'm your host, Alana, and it's time to connect.

Today's guest is someone who brings a deep expertise, compassion, and innovation to the field of gynecology.

Dr.

Megan Wasson is the chair of the Department of Medical and Surgical Gynecology at the Mayo Clinic in Arizona and a professor of obstetrics and gynecology at the Mayo Clinic College of Medicine and Science.

Her clinical focus includes endometriosis, chronic pelvic pain, and advanced surgical techniques.

Dr.

Wasson is helping redefine what care can look like for patients around the world.

Please help me in welcoming Dr.

Megan Wasson.

Let's talk about the myth of menopause cures endometriosis.

Why isn't that always true?

Or so number one, um, one of my biggest pet peeves with endometriosis in general is when individuals have their uterus removed, their ovaries removed, and nothing is done for endometriosis, but I cured your endometriosis.

Nothing could be further from the truth.

So endometriosis, yes, it responds to the hormones that the ovaries release, but it's not an issue with the ovaries.

It's an issue with how that tissue is responding.

So we need to focus on fixing that tissue rather than just castrating everyone and removing ovaries.

So I very, very rarely am removing ovaries for treatment of pelvic pain for treatment of endometriosis.

And the reason for that is if we really understand endometriosis, it truly is endometrial-like tissue.

It is not the endometrium.

So endometriosis has a chemical in it called aromatase, and aromatase converts testosterone into estrogen.

So even if the ovaries are gone, the endometriosis is going to continue to feed itself.

And so whether that's surgical menopause, natural menopause, medical menopause, using those various medications that I previously mentioned, symptoms can continue.

Symptoms can't progress.

And we shouldn't just ignore them and say, well, I guess you're menopausal and there's nothing else we can do.

So now you really have to just suck it up and deal with.

I think there's a lot of fear as well when you get into this stage and you want to do hormone replacement therapy.

And I think that a lot of people are leery of doing that because they have endometriosis and they don't want to make it worse.

Can you touch on that just a little bit?

Because I think that is a fear of a lot of these people walking through the stage of life.

Yeah, and that's where you really need to understand how these hormones interplay and what affects endometriosis.

I recently just saw a patient, she came in, was getting testosterone supplementation, and was completely asymptomatic.

Endometriosis had never even entered the conversation until she was getting that testosterone, and all of a sudden she developed severe pelvic pain and no one could understand why.

Well, endometriosis converts that testosterone into estrogen.

And so it just caused that vicious cycle to really ramp up.

So that being said, hormone replacement therapy is not the enemy.

We just need to be very mindful and very cognizant about what we're doing with hormone replacement therapy and balancing those risks and benefits.

So just another plug for why removing the ovaries doesn't really make sense.

So if you have someone who is very young and you remove the ovaries, you induce menopause, the immediate next thing is going to be, well, now you're at risk for osteoporosis, heart disease.

I need to give you hormones now to reduce that risk.

So we've taken the hormones away, but now I'm gonna give you hormones because you need the hormones in your body.

It just doesn't logically line up.

Right.

So that's another point for why we just really shouldn't be doing that.

But after menopause, in that perimenopausal transition, there's a lot of other symptoms that can arise.

Hot flashes, difficulty sleeping, that brain fog is very common and hormones can help with that.

And so if you need hormones to help to support your body during that transition, absolutely we can do that.

If someone still has a large amount of disease burden with endometriosis, so that patient who we've been following with endometriomas hasn't wanted to do surgery, I do recommend estrogen and progesterone together in that patient, even if they've had a hysterectomy.

So for some individuals, after hysterectomy, we say only estrogen, you don't need any progesterone.

But on the flip side of that, if it's someone who's had a very thorough excision of endometriosis or not suspicious of significant disease burden remaining, that's where someone can use estrogen alone, and that's completely fine.

If they need estrogen to help with those menopausal symptoms, absolutely endometriosis is not a contraindication to hormone replacement therapy.

That's a wrap for this quick connect.

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