Endometriosis in Later Life: A Hidden Healthcare Inequality

In honour of International Women's Day, Elisabeth Langmann highlights the importance of talking about women's healthcare through an intersectional lens in discussing her recent open-access paper, co-authored with Anna-Christina Kainradl, Merle Weßel, and Alekszandra Rokvity, "Endometriosis in Later Life: An Intersectional Analysis from the Perspective of Epistemic Injustice":

Endometriosis has long been framed as a disease of reproductive age – something that affects menstruating individuals and supposedly disappears with menopause. But what happens when these assumptions mean that suffering goes unnoticed, and necessary care is withheld? What happens when postmenopausal individuals continue to experience symptoms, yet the medical system fails to recognize or address their suffering?

In our recent paper, Endometriosis in Later Life: An Intersectional Analysis from the Perspective of Epistemic Injustice, we critically examine how sexism, ageism and epistemic injustice shape the experiences of postmenopausal individuals with endometriosis. 

We argue that the invisibility of endometriosis in later life is not just a gap in medical knowledge – it is a systemic injustice with real, harmful consequences.

Endometriosis is a chronic inflammatory condition affecting an estimated 10% of biological women. Despite its prevalence, it remains largely misunderstood. 

One of the most persistent myths is that endometriosis vanishes after menopause due to the decline in estrogen levels. This belief is deeply ingrained in both medical literature and public discourse. However, research shows that a significant number of individuals continue to experience symptoms well into perimenopause and beyond.

Yet major menopause guidelines, including those from the European Menopause and Andropause Society and the North American Menopause Society, fail to mention endometriosis – leaving postmenopausal individuals without recognition, research, or care. 

This silence has consequences: when healthcare professionals do not recognize endometriosis in postmenopausal individuals, symptoms are dismissed, misattributed to other conditions, or outright ignored.

Our research highlights how gender and age intersect to shape the marginalisation of older women with endometriosis. While gender bias in endometriosis diagnosis has been well-documented, where individuals are told that their pain is “normal” or “all in their head”, less attention has been given to how ageism compounds this issue, making older women more vulnerable to dismissal and misdiagnosis.

This erasure is reinforced by the perception that older women are unreliable sources of knowledge about their own bodies. Their reports of pain are dismissed not only because of long-standing biases about female pain, but also because of assumptions that postmenopausal individuals are no longer affected by reproductive health conditions. This results in testimonial injustice – where individuals are denied credibility due to prejudiced assumptions about their age and gender.

At the same time, the medical system lacks the necessary interpretive frameworks to recognize endometriosis in later life. When postmenopausal women seek medical care for pelvic pain or other symptoms, their experiences are often filtered through ageist and sexist biases. 

Instead of investigating endometriosis as a possible cause, healthcare providers may attribute symptoms to “normal ageing” or conditions unrelated to endometriosis. This is an example of hermeneutic injustice, where a lack of shared knowledge prevents individuals from making sense of and communicating their experiences.

Why This Matters: A Call for Change

The exclusion of postmenopausal individuals from endometriosis research, clinical guidelines, and public health discussions is more than an oversight, it is a structural injustice. As long as endometriosis remains framed as a disease of reproductive age, those who experience symptoms later in life will continue to be disbelieved, misdiagnosed, and left without adequate care. 

To address this, we argue for a lifespan approach to endometriosis, one that recognizes the possible persistence of the disease beyond reproductive age, integrates postmenopausal individuals into research, clinical guidelines, and public health policies, and challenges ageist and sexist biases in healthcare that shape medical knowledge and practice. 

Endometriosis does not end with menopause – but the belief that it does continues to shape who receives care and who is left suffering in silence. Thus, if endometriosis can last a lifetime, so should our commitment to recognizing, researching, and addressing it.

 

Elisabeth Langmann is a postdoctoral researcher in bioethics at the Institute of Ethics and History of Health in Society (IEHHS) at the University of Augsburg, Germany. Her research focuses on structural inequalities in health, particularly ageism, ableism, and the systemic exclusion of marginalised groups in healthcare. She is currently part of the DFG-funded project "Centring Marginalisation for Effective and Just Public Health Policy and Practice," examining how public health policies engage with marginalisation, whose experiences remain unrecognized, and what shifts are needed for more inclusive approaches. Rooted in feminist bioethics and social justice, her work explores how power, knowledge, and institutional biases shape health experiences.