Menopause is associated with a decrease in sexual function among women with endometriosis.

Background: Menopause-related endocrinological shifts are linked to sexual dysfunction, and women with endometriosis exhibit lower Female Sexual Function Index (FSFI) scores, indicating impaired sexual well-being.

Aim: To assess the impact of menopause on sexual function in women with endometriosis.

Methods: An anonymous online survey was conducted among 1586 French women diagnosed with endometriosis. The FSFI questionnaire was used to evaluate sexual function, and menopause was defined as ≥12 months of amenorrhea. Multivariable logistic regression was performed to assess the relationship between FSFI scores and menopause status, adjusting for tobacco use, education, number of symptoms, and history of surgery. Logworth analyses were used to determine the strongest components of FSFI associated with menopause.

Outcomes: The primary outcome was the FSFI total score and its six domains (desire, arousal, vaginal lubrication, orgasm, satisfaction, and dyspareunia) in menopausal and non-menopausal women with endometriosis.

Results: Menopausal women had significantly lower FSFI scores (15.3 vs. 16.9, P = 0.021). After adjustment, FSFI remained significantly lower (P = 0.026) in menopausal women but did not reach the established FSFI cutoff for sexual dysfunction (P = 0.451). Stratified analysis by age showed a steep decline in FSFI between 46 and 50 years, partial improvement at 51-55 years, and further decline after 55 years, particularly in arousal, orgasm, dyspareunia, and satisfaction. Arousal (logworth = 4.53, P < 0.001) was the most affected domain, followed by satisfaction (logworth = 1.81, P = 0.015).

Clinical implications: Arousal appears to be the key determinant of sexual function decline in menopausal women with endometriosis, highlighting the need for targeted interventions such as hormone therapy, pain management, and sexual counseling.

Strengths & limitations: The study benefits from a large sample size and validated FSFI assessment but is limited by selection bias from online recruitment, self-reported diagnosis of endometriosis, and lack of hormonal status confirmation. The cross-sectional design prevents causal inferences.

Conclusion: Menopause is associated with a decline in FSFI scores among women with endometriosis, with arousal being the most affected domain, underscoring the need for further research on personalized management strategies for sexual dysfunction in this population.