Study links endometriosis and infertility to early menopause risk: what Canadian patients should know

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

A study published in June 2026 in Menopause, the peer-reviewed journal of The Menopause Society, found that among nearly 1,000 participants, women with endometriosis reached menopause approximately 2.75 years earlier than women without the condition, and women with unexplained infertility reached it 1.45 years earlier. Women with primary infertility overall arrived at menopause about one year earlier on average. For the estimated two million Canadians living with endometriosis, a figure cited by Endometriosis Network Canada, this means the conversation about long-term hormonal health may need to start much earlier in life than most patients or clinicians currently expect.

The findings matter in a Canadian context because early menopause (before age 45) and premature menopause (before age 40) carry documented risks for osteoporosis, cardiovascular disease, and neurocognitive disorders. A Canadian patient who has already navigated an endometriosis diagnosis or years of infertility treatment is now facing a third layer of long-term health planning, one that the Canadian health system is not yet systematically set up to address. The SOGC (Society of Obstetricians and Gynaecologists of Canada) has not yet issued a specific position statement responding to this study, and Health Canada has not issued updated guidance on early menopause screening for this population.

What this means in Canada

Endometriosis affects at least one in ten women in Canada, according to Endometriosis Network Canada, though the true number is likely higher given well-documented diagnostic delays. Toronto-based obstetrician-gynecologist and menopause specialist Dr. Michelle Jacobson, quoted in the Global News report on the study, said the association was "not a shock" clinically, partly because women with endometriosis often undergo multiple surgeries that reduce ovarian reserve over time.

For patients already in the system, the practical question is whether their care team is connecting the dots between a past endometriosis or infertility diagnosis and future menopause timing. In most provinces, that conversation happens, if at all, through a specialist referral. Menopause care in Canada sits in a fragmented space: family physicians handle most of it, but wait times for gynecologists or menopause specialists can stretch months in Ontario, British Columbia, and Alberta. Virtual platforms including Cleo (a Canadian women's-health platform), Felix, and Science & Humans (scienceandhumans.com) offer menopause-related consultations, though none currently advertise a specific early-menopause risk pathway for patients with endometriosis histories. US-only platforms such as Midi Health and Hone Health do not serve Canadian patients.

Hormone therapy for early or premature menopause is available in Canada. Estradiol products approved by Health Canada include oral estradiol (Estrace) and transdermal options (Estradot patch, Climara patch), among others. Provincial drug benefit coverage varies: in Ontario, OHIP does not cover the specialist visit itself under a menopause-specific billing code, and drug coverage through the Ontario Drug Benefit program depends on age and income. In Quebec, RAMQ covers some hormone therapy products for eligible patients. British Columbia's PharmaCare and Alberta's AHCIP have their own formulary criteria. Patients should check their provincial plan directly, as coverage for early-menopause hormone therapy in women under 45 is not uniform across the country.

What changed

This study does not establish a new risk factor from scratch. As Dr. Jacobson noted, the endometriosis-menopause link has been observed in clinical practice for years. What the study adds is a quantified estimate from a structured cohort of nearly 1,000 women, giving clinicians a concrete number to use in counseling: 2.75 years earlier for endometriosis, 1.45 years earlier for unexplained infertility.

The Menopause Society's medical director, Dr. Stephanie Faubion, said in the study release that women with primary infertility and a history of endometriosis "may benefit from counseling that they are at risk of early menopause" so they can monitor for it and seek hormone therapy if indicated. That is a shift in emphasis: from reactive diagnosis to proactive monitoring.

The study lands alongside a growing body of Canadian research on endometriosis. A May 2026 study in the Canadian Medical Association Journal (CMAJ) analyzed more than 1.4 million Ontario births between 2006 and 2021 and found that babies born to people with endometriosis had a congenital anomaly rate of 6.3 percent, compared to 5.4 percent in the general birth population. A separate April 2026 trial published in The Lancet tested a SPECT-CT imaging technique using a molecular tracer called maraciclatide to detect endometriosis non-invasively, correctly identifying the condition in 16 of 19 participants. That technique is still in early-phase research.

Taken together, these studies point toward a period of accelerating clinical knowledge about endometriosis, though Canadian health policy has not kept pace. Endometriosis Network Canada called for a National Action Plan for Endometriosis in 2024. Green Party Leader Elizabeth May has indicated she will bring a petition to the House of Commons seeking federal recognition of endometriosis as a disability.

What Canadian patients should know

If you have a confirmed or suspected endometriosis diagnosis, or a history of unexplained infertility, the practical takeaway from this study is to ask your clinician directly about early menopause risk at your next appointment. Perimenopause is the multi-year transition before menopause when hormone levels fluctuate unpredictably; it can begin years before the final menstrual period, and its symptoms (irregular cycles, sleep disruption, mood changes, vasomotor symptoms) are often attributed to other causes in younger patients.

Specific questions worth raising:

• Has my ovarian reserve been assessed recently, and what does it suggest about my reproductive timeline?
• At what age should I start monitoring for perimenopause symptoms given my history?
• If I reach menopause before 45, what are my options for hormone therapy, and what does my provincial drug plan cover?
• Are there lifestyle factors, including smoking cessation and weight management, that could affect my menopause timing?

Dr. Jacobson also pointed to the importance of not smoking and maintaining a healthy body weight as modifiable factors that affect both fertility and the body's hormonal aging. Endometriosis itself is not modifiable, but the number and extent of ovarian surgeries may be a factor clinicians can weigh when planning treatment.

Provincial differences matter here. A patient in Quebec with RAMQ coverage may have different access to hormone therapy than a patient in Nova Scotia or Manitoba. If your family physician is not familiar with early menopause management, a referral to a gynecologist or a menopause specialist is reasonable to request.

Limitations and open questions

The study published in Menopause has not yet been independently replicated at scale. The cohort of nearly 1,000 participants, while meaningful, is not large enough to draw population-level conclusions with certainty, and the study design does not establish causation. The observed associations could partly reflect the effect of endometriosis surgeries on ovarian reserve rather than the underlying condition alone, a distinction the study does not fully resolve.

Health Canada has not issued updated guidance on early menopause screening for women with endometriosis or infertility histories. The SOGC has not yet issued a position statement responding to this specific study. The Menopause Society's statement from Dr. Faubion recommends counseling and monitoring, but stops short of recommending a specific screening protocol or age threshold.

The non-invasive SPECT-CT imaging technique from the Oxford trial is still in phase-two research and is not available in Canadian clinical practice. The CMAJ birth-defect study, while large, covers Ontario births only and may not generalize to all Canadian populations.

What is clear is that the clinical picture of endometriosis as a condition with long-term systemic consequences, beyond pelvic pain and fertility, is becoming harder to ignore. Whether Canadian health policy will respond with structured screening pathways or expanded coverage for early menopause care remains an open question.

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This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

Editorial note

Hormone Journal articles are written by our editorial team and reviewed against published clinical guidelines, with a focus on Canadian patient access. We do not promote specific clinics or providers.