In recent years, endometriosis has become a significant factor contributing to menstrual pain, affecting girls at increasingly younger ages. According to the World Endometriosis Association, more than 180 million women worldwide suffer from this condition. However, these figures may not provide a complete picture, as many adolescents who experience specific symptoms are often diagnosed much later. A diagnosis of endometriosis can be delayed by up to 10 years, precisely because doctors do not believe that adolescents can be affected by this condition.
Adolescents are often considered to be exaggerating when they complain of such pain, especially to drop out of school. Moreover, some gynecologists do not feel comfortable treating or examining a teenage girl. If we add to all this the myths learned over the generations that still work, the beliefs that pain and mood swings are normal for any menstruating woman, this is how teenagers waste valuable time in correctly diagnosing their potential conditions. At that moment, the harm is already done.
That is why adolescents who have such symptoms, accompanied or not by abundant flow, should see a doctor as soon as possible. The latter should be taken into account in medical investigations, mainly the pain that the patient accuses, and endometriosis should be the first to be considered for a differential diagnosis, precisely to avoid its establishment with a delay of up to 10-12 years, following worsening of symptoms.
Diagnosing adolescents is a sensitive topic, especially if patients are still virgins. In these cases, doctors must carefully perform both the clinical examination and the investigation of the patient’s history, through questions related to the context in which she lives, evaluation of the patient’s education, her activities, drug use, suicide, and depression attempts, related history of reproductive health (questions about menarche – first menstruation, frequency and regularity of the menstrual cycle, possible pregnancies or abortions, use of oral contraceptives or hormonal treatments). Questions about the history of surgery, as well as family history of endometriosis and possible cancers, are also helpful.
Confidentiality assurances should be offered and explained to the patient and her family.
Physical examination is also essential in determining the most accurate and complete diagnosis and to rule out other disorders that may require immediate attention. The exam also includes evaluation to determine the position, size, and mobility of the uterus: a rigid, retroverse uterus could indicate severe adhesions (strips of connective fibrous tissue that stick to each other’s internal organs preventing them from moving freely). Furthermore, the doctor may also perform a recto-vaginal examination to palpate the uterosacral ligaments and the recto-vaginal septum, revealing any nodules or deep endometriosis. The masses of the appendages discovered during the examination may suggest ovarian endometriosis.
Pain occurring during the menstrual cycle, as well as outside of it, may exhibit the following characteristics:
- Dysmenorrhea – painful menstruation
- Dyspareunia – pain during intercourse
- Dysuria – pain during urination
- Dysketia – pain during defecation
- Low back pain
- Abdominal discomfort
- Chronic pelvic pain (lasting cyclically, more than 6 months)
Atypical pain may manifest as leg pain, along the sciatic nerve, hematuria (bleeding due to bladder or colon issues), secondary dyspnea (difficulty breathing), or pneumothorax (air entering the pleural cavity).
The diagnosis of endometriosis can be easily suspected in cases of dysmenorrhea that do not respond to analgesic drugs, pelvic stiffness, or palpation of any nodules in the rectovaginal septum, uterosacral ligaments, or via ultrasound examination indicating the presence of typical ovarian cysts of endometrioma. In such cases, laparoscopy is not necessary, but treatment should commence. Laparoscopy should only be performed if the physician is prepared to excise the lesions caused by endometriosis, as evidence shows that surgical management provides long-term pain relief in over 50% of cases.
According to studies by Canadian obstetricians and gynecologists, surgical management is indicated in the following scenarios:
– Patients experiencing pelvic pain unresponsive to drug therapy or with contraindications to it
– Ruptured ovarian cysts
– Severe endometriosis causing damage to the intestines, bladder, or pelvic nerves
– Suspected cases of ovarian endometrioma
– Patients experiencing daily management challenges due to an uncertain diagnosis (chronic pelvic pain)
– Patients dealing with infertility and related factors such as pelvic adhesions or pain.
The decision to proceed with surgery should follow clinical evaluation and imaging (ultrasound, pelvic MRI with an endometriosis protocol – distinct from a standard MRI, hydro-colon CT, or due to a lack of response to medication). This approach may limit laparoscopic diagnosis.
All of the above considerations can guide a young patient’s preparation for a high-quality gynecological consultation, conducted by proficient endometriosis specialists.
Sources: endopaedia.info, well.blogs.nytimes.com, assets.cewekbanget.id