Does menopause cure endometriosis?

There has never been a biopsy-controlled study showing that menopause eradicates, destroys, or cures endometriosis. Nor has there has ever been a biopsy-controlled study showing that removal of the ovaries eradicates, destroys or cures endometriosis. One of the oldest patients with endometriosis, aged 78, was reported by Haydon.

The oldest patient with biopsy-proven endometriosis ever treated at the St. Charles Endometriosis Treatment Program was 74. So strong is the notion that removal of the ovaries will destroy endometriosis, that this elderly patient had her uterus, tubes and ovaries removed at the age of 73 in order to "cure" her endometriosis, even though she was not on estrogen and had received radiation therapy in the 1940s to destroy her ovaries.

Where did the notion arise that menopause (and, by inference, removal of the ovaries) could destroy endometriosis? Since he had not seen endometriosis after the menopause, Sampson had "hope" that cessation of ovarian function would "usually, possibly always", "probably" cause atrophy of endometriosis.

Endometriosis requires more than verbs and adverbs for its treatment. Meigs aggravated this, ignoring among his 16 menopausal endometriosis patients the fact that two still had ovarian endometriomas. He proposed removal of the ovaries as a method of stopping ovarian function which would make the cysts within the ovaries stop growing and slowly atrophy. As an example of the "success" of this therapy, he reported the case of a patient whose pelvic mass (which was presumed to be ovarian endometriosis) persisted for 25 months after removal of her ovaries. (sic) Proponents of the menopausal eradication theory seemed to have a knack for offering unsupported opinions or misinterpreting data. Cattell and Swinton stated that "castration will cause the lesion to recede and usually relieve symptoms," although no data or references were offered in support. Cattell later noting that 54% of patients with significant bowel disease continued to be symptomatic or have abnormal GI x-rays after castration, although he did not discuss the rationale of a therapy which left most patients with abnormalities.

Fallon, writing without supporting references, stated that "... all endometriosis regresses after removal of the ovaries...". Counsellor and Crenshaw stated (without references) that "Obviously, the quickest and most certain way for the relief of pain is the destruction of the ovarian function."

Of course, it is now realized that these early studies on menopause and endometriosis based their conclusions on observations of symptoms or apparent rates of diagnosis of endometriosis among menopausal patients: patients seemed to hurt less or not at all after the menopause, and since gynecologists rarely saw endometriosis after the menopause, it was concluded that menopause physically destroyed the disease. They did not use biopsy-controlled studies to prove these opinions, and there remains to this day no proof that menopause destroys endometriosis.

Kempers reported 138 endometriosis patients who were 2 or more years post-menopausal. Only two had been on estrogen. Sixty-one percent had been pregnant and 41 had clinically significant intestinal disease. At St. Charles' Endometriosis Treatment Program, we had a series of 65 patients with biopsy-proven endometriosis after hysterectomy and oophorectomy. Some of these patients were in their 20's and had not had children. They were told that hysterectomy and castration with retention of their disease would cure their endometriosis.

For a doctor to believe that menopause is a good treatment for endometriosis, he must believe that women do not need estrogen. Additionally, for natural or surgical menopause to work, some as-yet-undescribed, miraculous cytocidal histo-hormonal effect must occur. So far, the only support for this mysterious effect is the shrill chorus of those without historical or scientific perspective who still believe that it occurs.