Endometriosis in Teens
It's time to listen to your body.
Especially if you're experiencing period pain.
You might've been told that period pain is normal. But that's not exactly true. Period pain is a common symptom, but isn't always normal.
Cramping in your lower pelvis or back is normal around the start of your period, but experiencing severe pain isn't. If you feel a stabbing, burning, or throbbing pain that doesn't go away with pain killers, and is causing you to miss school or work, and affecting your quality of life - you need to figure out what's going on.
One of the emerging causes of period pain in teens is endometriosis. Endometriosis happens in about 10% of women who menstruate (likely more!). It was previously thought that teens didn't have endometriosis because research only looked at older women who were having trouble getting pregnant.
What is endometriosis?
Endometriosis is a gynecologic disease that occurs when endometrial tissue grows outside your uterus. This tissue can grow anywhere in your body (it's even been found on the lungs and brain), but it's most commonly found on the ovaries, fallopian tubes, uterine surface, bowel and the lining of the pelvic cavity.
When you experience your monthly period, you also experience internal bleeding and ultimately scar tissue will form. Sounds great, right? #noway
Common endometriosis symptoms in adults
Some of the common symptoms associated with endometriosis are:
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Painful urination
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Chronic pelvic pain
Other symptoms include:
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Acute abdominal pain
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Severe constipation
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Diarrhea
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Nausea
How does endometriosis present in teens?
You might notice pain that doesn't quite sync with your period (aka. noncyclic pelvic pain). Also, if your mom or sister have endometriosis, or if you have a history of atopic disease (ex. eczema, asthma) - you should be checked!
Endometrial lesions might be found between your ovaries, peritoneum, pouch of Douglas, uterosacral ligaments and rectovaginal septum. Typically, the lesions may present differently than they would in adults. Yours might be more red and clear.
Because of these differences, this may contribute to your delay in diagnosis, and ultimately treatment. Obviously this lag may negatively impact your quality of life.
Warning signs in teens
Pay attention to these signs:
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Extended use of anti-inflammatory drugs (ex. NSAIDs)
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Family history of endometriosis (ex. mom and sister)
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Frequent absence from school during your period, and skipping exercise because of pain or a heavy flow
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Birth control prescription before you turn 18 because of pain
How is endometriosis diagnosed?
You can't diagnose endometriosis through a blood test. Instead, the gold standard of testing is a laparoscopic exam. This is considered a minimally-invasive surgery where small incisions are made in the abdomen to both confirm the presence of and remove endometrial lesions.
Doctors may suggest ultrasounds to see if you have endo, but that test can't completely rule endo out.
Conventional Treatment of Endometriosis
Unfortunately there's no cure for endometriosis. But treatment should include controlling pain and preventing lesion progression.
The first line treatment in endometriosis is birth control (usually a combined pill). This may actually be worthwhile to try if the pain is incredibly severe, and not responding to regular painkillers. Nevertheless, there are a few things to consider if you plan on taking birth control:
A huge study in 2016 investigated different types of birth control and how they were associated with antidepressants and a diagnosis of depression. Researchers found that teens (between 15 to 19) are more sensitive to depressive symptoms and antidepressants than adults. This was seen in teens using the combined pill or progestin-only pill. The study did show that the incidence of depression and antidepressants use decreased with age.
Teens with endometriosis report impaired physical and mental health quality of life. As well as physical pain, difficulty in participating in daily activities, physical activities, and social events. Therefore all of these factors must be considered when determining the best treatment route, or adjunctive supportive therapies.
Naturopathic Treatment of Endometriosis
Once again there isn't a cure for endometriosis, but you can do a couple of things to manage the pain and improve quality of life. There are some supplements that you can take, but it should really be done under the supervision of a health practitioner like a Naturopathic Doctor.
You may want to consider:
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FODMAPs diet or an anti-inflammatory diet
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Curcumin
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N-acetyl cysteine
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EPA/DHA
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Selenium
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Vitamin E
Next Steps
If you've been experiencing any of the warning signs, it may be time to talk to your doctor about endometriosis.
If you found this information helpful, I would encourage you to download my FREE EndoDiet meal guide and plan. It goes through everything we discussed: foods that are safe and that should be avoided, and a 7 day meal plan and preparation guide!
References
Dowlut-McElroy, T. and Strickland, J. (2017). Endometriosis in adolescents. Current Opinion in Obstetrics and Gynecology, 29(5), pp.306-309.
Gallagher, J., DiVasta, A., Vitonis, A., Sarda, V., Laufer, M. and Missmer, S. (2018). The Impact of Endometriosis on Quality of Life in Adolescents. Journal of Adolescent Health, 63(6), pp.766-772.
Reid, R., Steel, A., Wardle, J. and Adams, J. (2018). Naturopathic Medicine for the Management of Endometriosis, Dysmenorrhea, and Menorrhagia: A Content Analysis. The Journal of Alternative and Complementary Medicine.
Zannoni, L., Forno, S., Paradisi, R. and Seracchioli, R. (2016). Endometriosis in Adolescence: Practical Rules for an Earlier Diagnosis. Pediatric Annals, 45(9), pp.e332-e335.