Endometriosis and Menopause: A Policy Blindspot in Women’s Health
Estimated Reading Time: 4 minutes
By Sage Womens Health in partnership with QENDO
Despite decades of advocacy, policy advances, and growing public awareness, endometriosis remains a misunderstood and under-addressed chronic condition. While significant progress has been made including the development of the 2018 National Action Plan on Endometriosis, there is a persistent and concerning blindspot in women’s health policy: the intersection of endometriosis and menopause.
The Power of Advocacy: A Milestone Moment
This is where Sage’s alignment with partners like QENDO and WOVEN is essential.
QENDO, alongside leading organisations such as EndoActive and the Pelvic Pain Foundation of Australia, helped drive a coordinated push for government action on endometriosis. This collective advocacy led to the development of the 2018 National Action Plan on Endometriosis - Australia’s first national strategy to address the health, social, and economic impact of the disease.
A key outcome of the plan is the Supporting Workers with Endometriosis in the Workplace guidance from Safe Work Australia - a milestone in framing endometriosis as a workplace health and safety issue.
But even within these significant strides, a policy blindspot remains: the lack of support for women navigating both endometriosis and menopause. This is where Sage’s alignment with partners like QENDO and WOVEN is essential.
Why a Life Course Approach is Essential
Australia’s National Women's Health Strategy 2020–2030 calls for better coordination of care across the lifespan. But too often, policy still treats women’s health as a series of disconnected stages like puberty, fertility, and menopause, rather than a continuum of interconnected experiences that spans decades.
Endometriosis is a clear case in point. While it is typically framed as a “reproductive age” condition, growing evidence shows that symptoms can persist through perimenopause and postmenopausal years. A 2023 study in Acta Obstetricia et Gynecologica Scandinavica found that 2 - 4% of postmenopausal women continue to experience symptoms, and some may develop endometriosis as a new condition after menopause.
This reinforces the need for a life course model of care - one that sees endometriosis not as time-bound but as a lifelong chronic disease that intersects with hormonal transitions, comorbidities, and workplace realities.
A Timeline of Symptoms That “Don’t Retire at 50”
Endometriosis is typically diagnosed by the time a woman is in her late 20’s or early 30’s, with an average time to diagnosis of 6.5 years. Pain, fatigue, bowel and bladder dysfunction, and psychological distress are all hallmark symptoms of endometriosis, and they don’t necessarily disappear when periods stop.
In perimenopause, a time of accelerated ageing, around 65% of women experience ‘bothersome symptoms’ that affect daily life, lasting typically for 2 - 10 years, or longer in some cases. The most common symptoms include fatigue, brain fog, insomnia, anxiety and mood disorders.
The hormonal changes during perimenopause and menopause can reignite endometriosis symptoms or create new complexities, especially for those using menopausal hormone therapy (MHT). In rare cases, postmenopausal endometriosis may even lead to malignant transformation.
Despite these seemingly parallel experiences, current care pathways, workplace guidance, and public awareness largely ignore this intersection and fail to recognise the continuity of symptoms, which leaves many without support or recognition at a critical life stage.
Workplace policy provides a perfect opportunity to address the individual and intersectional concerns of endometriosis and menopause.
Bridging Policy, Work and Science
Workplace policy provides a perfect opportunity to address the individual and intersectional concerns of endometriosis and menopause. Endometriosis already costs the Australian economy $7.7 billion annually in healthcare, absenteeism, and lost productivity. Menopause is thought to cost upwards of $10 billion annually in Australia, with a detailed study from 2013 showing that the direct and indirect costs of menopause are in the order of $10,500 per employee per year.
Workers managing either condition or both endometriosis and menopausal symptoms - particularly in high-pressure, shift-based, or male-dominated industries - may face compounded fatigue, cognitive strain, and health risks. But no integrated support frameworks exist.
There’s a critical need to bring together:
WHS laws and flexible work design
Health guidelines for MHT and chronic disease management
Anti-discrimination protections that span age, disability, and reproductive health
This is precisely where a cohesive women’s health policy must step in — grounded in real-world complexity rather than fragmented conditions.
From Correlation to Causality: The Research Gap
This research is vital not only for developing safer, more personalised treatments, but for informing policy that is proactive rather than reactive.
Critically, advancing care also requires better science. Much of what we know today about the relationship between endometriosis, menopause, MHT, cancer risk, and chronic comorbidities is correlational, not causal.
That’s why researchers like Dr. Michael Liebman, founder of WOVEN (the not-for-profit arm of IPQ Analytics), are leading efforts to shift the research paradigm by focusing on causality, context, and patient-specific factors to improve health outcomes. Through systems biology and integrative data models, WOVEN is working to identify patterns that traditional studies often miss, particularly in under-researched conditions like endometriosis and menopause.
This research is vital not only for developing safer, more personalised treatments, but for informing policy that is proactive rather than reactive.
Toward a Cohesive Women’s Health Policy
We believe the absence of guidance for women navigating both endometriosis and menopause is a major policy blindspot and a missed opportunity to create truly supportive systems for women and gender-diverse individuals across their lifetimes.
A forward-looking, life course approach should:
Acknowledge endometriosis as a lifelong condition, not just a reproductive one
Improve workplace and healthcare policies with provisions that support women through female-specific conditions such as endometriosis and midlife transitions
Fund and leverage research that moves from correlation to causality, so that women can understand their unique risk profile and get personalised support, sooner
Embed women’s health in employment law and WHS standards, reflecting both chronic and transitional needs
Integrate patient voice and lived experience into all levels of health system design and delivery.
What’s Next
QENDO, Sage and WOVEN remain committed to advancing a vision of women’s health that is continuous, evidence-based, and centred on lived experience. Together, we are calling for a future where no one is left behind at the intersection of chronic illness, hormonal transition, and structural oversight.
It’s time to move beyond siloed thinking and reproductive framing. Endometriosis and menopause are not separate chapters - they are part of the same health story. And that story deserves to be seen, heard, and acted upon.
References
Australian Government Department of Health and Aged Care (2020) National Women's Health Strategy 2020–2030. Canberra: Australian Government. Available at: https://www.health.gov.au/resources/publications/national-womens-health-strategy-2020-2030
Jakson, I., Lindén Hirschberg, A. and Gidlöf, S.B. (2023) ‘Endometriosis and menopause - management strategies based on clinical scenarios’, Acta Obstetricia et Gynecologica Scandinavica, 102(10), pp. 1323–1328. doi:10.1111/aogs.14583.
More Posts on Menopause
