Information for Teens
Endometriosis is considered to be a disease of women*, predominantly of reproductive age, which is between menarche (the first period during puberty) and menopause.
Following the introduction of laparoscopy in the 1980s, endometriosis was recognised as a disease that can affect adolescents and young women, whereas before it was believed that endometriosis in adolescents was rare.
In recent years, endometriosis in adolescents has been recognised as a challenging problem in gynaecology.
A recent review on this topic showed that:
The prevailing symptom of endometriosis in adolescents is persistent chronic pelvic pain, despite medical treatment (hormonal contraceptives and/or pain killers)
Adolescent girls with deep endometriosis had more school absences during menstruation and more frequently, and for a longer period, used an oral contraceptives to treat severe primary dysmenorrhoea. Serious gastrointestinal symptoms, including constipation, diarrhoea, nausea, and vomiting were also reported in adolescents with endometriosis.
What is the difference between "normal period pain" and symptoms of endometriosis?
With classical period pain, mild discomfort and cramping on the first 1-2 days of the period is usual, this is relieved with over the counter pain killers.
Speak to a GP if the pain:
Causes distress or inability to go to school/college
Causes absence from other activities (sport, social events, family events etc)
Occurs outside the first 2 days of the period
Is not relieved by treatments like the pill or painkillers are taken
If there is a family history of endometriosis
If your symptoms are not being heard - please seek a second (or third opinion).
* The term "women" is used in line with the scientific literature, it is not intended to exclude. Cis females, trans males and some rare cis males have had endometriosis diagnosed.
Endometriosis in Teens
Diagnosis of endometriosis in adolescents can be guided by symptoms and imaging (MRI and Ultrasound). In some cases, the clinician will proceed with first-line treatment - pain medication and/or hormonal medication (pill, Mirena, progestogens) without a laparoscopy. Where deep endometriosis is suspected by pelvic examination or endometrioma are seen on imaging - surgery may be offered to remove lesions and relieve symptoms.
Despite the deficit in definitive scientific literature, recent studies indicate that an early onset of chronic pelvic pain at the time of menarche (first period) represents a risk factor for severe endometriosis during adolescence. In addition, when endometriosis appears during adolescence, there is a likelihood that the disease will progress and, if left untreated, produce adverse effects that go beyond pain, and include infertility. Finally, a majority of adolescent girls with chronic pelvic pain that does not respond to conventional medical (hormonal) therapy, go on to have a diagnosis of endometriosis. For all these reasons, early identification of the disease may go a long way in slowing or preventing progression.
A number of medical and surgical options exist for the treatment of endometriosis. An early diagnostic procedure in adolescents with untreatable chronic pelvic pain can lead the gynaecologist to early identification of endometriosis, followed by a personalised treatment. Discussion with the adolescent, guardians and clinicians should include all aspects of the disease. It is important to consider the impact on the quality of life, attendance at school/college, future fertility plans. When endometriosis is suspected, all efforts should be taken to ensure the protection of the ovaries and ovarian reserve. Young women should not be exposed to multiple ineffectual surgical procedures. Where deep endometriosis or the presence of endometrioma (ovarian endometriosis) is suspected, the case should be referred to a clinician with relevant expertise in young women.
- Ballweg, ML. Big picture of endometriosis helps provide guidance on approach to teens: comparative historical data show endo starting younger, is more severe. J Pediatr Adolesc Gynecol 2003; 16 (3 Suppl): S21-S26.
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