Endometriosis is a progressive problem throughout life and menopausal status is no exception although rare. Postmenopausal endometriosis was first reported in 1950. It should be considered in women in postmenopausal age group, who present with classical symptoms of endometriosis, mostly pain. In women with surgical menopause, there is a 15% probability of persistent pain after hysterectomy for endometriosis and a 3–5% risk of worsening pain or new symptom development. Surgery is the first choice of treatment in women with postmenopausal endometriosis mainly due to the risk of malignancy. The lesions need to be surgically excised by a skilled surgeon by minimally access surgery. Laparoscopic treatment improves pain symptoms in these women.