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Endometriosis in Teens

Endometriosis is one of the most common gynecological diseases, occurring in 5-10% of women, but it is rarely diagnosed in teenage girls.1,2

While most commonly associated with women ages 30-45, it is possible for teens to experience endometriosis too.1 However, little research has been done into endometriosis in girls and teenagers, or how their symptoms might differ from those of older women.

Here is what we do know about endometriosis in girls and teenagers:

What are the symptoms of endometriosis?

One of the challenges in diagnosing endometriosis is that the symptoms tend to be vague and overlap with many other gynecologic and gastrointestinal conditions. The most common symptoms of endometriosis are:2

  • Pain before and during periods
  • Fatigue
  • Painful urination during periods
  • Painful bowel movements during periods
  • Diarrhea, constipation, and nausea

Since girls can start their periods as young as 8-10 years of age, two other symptoms are significantly less likely to be an issue as they may be in older teens and grown women:2

  • Pain during sex
  • Infertility

Many women with endometriosis also seem to suffer more frequently from:2

  • Allergies
  • Chemical sensitivities
  • Frequent yeast infections
  • Eczema
  • Asthma

Though the research is spotty, it seems that the most common symptom in teenage girls is pelvic pain that may or may not be consistent from one period to the next. However, in teens who have been diagnosed with endometriosis, the pain tends to increase in severity and frequency until it disrupts school and social activities.

How is endometriosis diagnosed?

While severe pelvic pain before and during menstruation is the most common symptom associated with endometriosis, painful periods can also be caused by other gynecological conditions, making an accurate diagnosis difficult. An age-appropriate physical exam and imaging techniques such as ultrasound or MRI are the first steps to getting a diagnosis of endometriosis.

There is only one way to definitively diagnose it and that is laparoscopy.1 Laparoscopy is a surgical procedure in which a tiny fiber-optic instrument is inserted through the stomach wall to view or operate on the organs in the abdomen. Laparoscopy allows doctors to see the lesions endometriosis creates and determine how many are present.

Interestingly, teens tend to have lesions that appear clear, red, white or yellow-brown. Adult women’s lesions tend to appear blue or black. Adding to the many mysteries of endometriosis, women with fewer lesions (as seen during laparoscopy) can experience severe side effects while those with more lesions can have mild side effects.1 In other words, the appearance or staging of endometriosis does not always correlate with the severity of symptoms.

Risk factors for endometriosis

There is growing evidence that genes play a strong role in who is most likely to experience endometriosis in their teen years.

One recent study looked at what little research does exist and found that there seem to be certain risk factors for endometriosis in adolescents, including:1

  • Congenital abnormalities of the pelvic region
  • A mother or sister with endometriosis (which accounts for a 50% risk of developing the disease)
  • Early onset of periods, particularly painful periods
  • Periods that last longer than 5 days
  • Less than 28 days between periods

A wide variety of other risk factors seem to play a role in developing endometriosis during the teenage years. These included exposure to secondhand smoke, walking more than 5 hours a week between ages 8-15, exposure to endocrine disrupting chemicals, low body mass index (BMI), acne, and higher caffeine and alcohol consumption. Being fed soy formula as an infant also seemed to increase the risk of developing endometriosis later in life.1

The importance of early detection

Since endometriosis leads to infertility in 30-50% of women with the condition, early identification may help prevent progression of the disease.

Unfortunately, most women must wait almost a decade to receive an accurate diagnosis of endometriosis. Typically, patients delay seeking professional medical help for an average 4.67 years and then the diagnosis takes another 4.61 years.2

Early detection may also help protect young women from other risks associated with endometriosis, such as ovarian and breast cancer and autoimmune disorders. Since endometriosis tends to increase in severity throughout a woman’s childbearing years, it’s important to seek treatment and manage the disease to reduce its progression.

  1. Sanctis V, et al. A focus on the distinctions and current evidence of endometriosis in adolescents. Best Pract Res Clin Obstet Gynaecol. 2018 Aug;51:138-150. https://doi.org/10.1016/j.bpobgyn.2018.01.023. Accessed 10/23/18.
  2. Endometriosis Fact Sheet. American College of Obstetrics and Gynecologists. Available at: https://www.acog.org/about_acog/.../millionwomanmarchendometriosisfactsheet.pdf Accessed 10/23/18.

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