When Can Endometriosis Develop?
The age group with the highest incidence of endometriosis has been slightly debated, however, most experts agree that women who are of reproductive age, roughly ages 25-40, are the most commonly affected by the condition.1,2 Despite this, endometriosis can be diagnosed at many points across the lifespan, including in adolescence and through menopause, but diagnosis before puberty and post-menopause is rare.
Endometriosis in the teenage years
Although most women are not diagnosed until adulthood, it has been estimated that nearly 70% of all women with endometriosis started experiencing symptoms before 20 years old, and that the condition can be diagnosed in teenagers and very rarely in children.3,4 One challenge of diagnosing young women with endometriosis is the potential lack of menstrual pain comparison. For example, a young woman with severe pelvic pain during her period may think that this pain is normal, especially if she hasn't experienced many periods before or hasn't disclosed this information to others who may tell her otherwise.
Teenagers who have an immediate family member who also has endometriosis, or who got their first period at a young age (such as at or younger than age 11) are typically at a higher risk for developing the condition. Diagnosis of endometriosis in teenagers is the same as in adults and is done via laparoscopic surgery. However, a unique aspect of teenage endometriosis-related care is that there are obstetric and gynecologic physicians who specialize in the care of adolescents. These physicians may be more aware of the needs of this population, especially for young girls who have never seen a women's health provider in the past.5
As mentioned, endometriosis is most commonly diagnosed in women between the ages of 25-40 years old. This age group makes up the largest proportion of the roughly 6.5 million women in the United States alone living with the condition.1,2 Since diagnosis of endometriosis can be a difficult and long process that is only confirmed with surgery, many adult women may have had the condition since adolescence. Symptoms in adulthood are similar to those in adolescence, and treatment also depends on the severity of the condition, symptoms experienced, desire to have children, and personal medical history.2,6
If an adult woman is not trying to become pregnant, she may be placed on hormonal therapy or undergo surgery, including a complete hysterectomy. If an adult woman is trying to have a baby, she may be placed on medications called gonadotropin-releasing hormone (GnRH) agonists, and surgical interventions that could impact fertility may be avoided. An adult woman's ability to get pregnant with endometriosis depends on the severity of the condition, what, if any, reproductive structures are affected by endometrial lesions, and if the ovaries, or the unfertilized eggs within them, are impacted by the condition.2,6-8
Pregnant women with endometriosis often report that their symptoms decrease while they are pregnant. This may be due to the hormonal changes and lack of a menstrual cycle during pregnancy. However, it's important to note that pregnancy is not a cure for endometriosis. Additionally, research suggests that pregnant women with endometriosis may have a higher risk of delivering preterm, undergoing a cesarean section (C-section), experiencing pre-eclampsia (high blood pressure and protein in the urine that develops later in pregnancy), placental complications, and bleeding during pregnancy, among other pregnancy-related complications. It is also possible for atypical endometrial lesions to develop during pregnancy, regardless of the potential decrease in physical symptoms experienced. Despite the potential complications though, it is possible for a woman with endometriosis to get pregnant, remain healthy, and deliver a healthy baby.9-11
If endometriosis symptoms subsided during pregnancy, they may return after birth. The return of these symptoms can vary from person to person. Some experts think that the return of endometriosis symptoms may be delayed if a woman breastfeeds for an extended period of time, however, this is only thought to delay symptoms if it is happening regularly enough to impact the return of a woman's regular menstrual period. If a woman thinks she will no longer have any more children after she gives birth, new treatment options may be pursued, especially if her original treatment regimen was designed to increase the potential of getting pregnant. This means that these women may now be able to undergo surgical interventions or try different medications that may have impacted their ability to get pregnant in the past. These newly accessible interventions may help provide a woman with further relief, depending on her specific situation.2,11
Endometriosis after menopause
Since endometriosis is a condition that is thought to be, at least in part, dependent on hormones like estrogen, it makes sense that menopause might provide some relief from the condition. During menopause, menstrual periods stop, and the ovaries' production of hormones like estrogen and progesterone changes dramatically. For some individuals, these changes may lead to relief from endometriosis symptoms, however, for others, this may not be the case. The body still makes low levels of estrogen and other hormones, and hormonal therapy or surgical interventions may still be needed to further relief. If you are experiencing symptoms post-menopause, talk with your doctor or healthcare provider about treatment options for your specific situation.12,13