Many endometriosis sufferers have had their symptoms started from a young age. What is the youngest patient that you have seen?
The youngest patient I have seen with endometriosis was a 15-year-old girl, who had menarche five years before the diagnosis. It is likely that, in this case, the disease progressed during the 5 years from menarche to the diagnosis.
Is endometriosis in teenagers different than in adult/older people? Does it behave differently?
Endometriosis is usually found in less severe stages in early adolescence compared with adult women. This may be due, at least in part, to the fact that unfortunately there is a diagnostic delay of many years to get a proper diagnosis, and usually during this period the disease progresses as well as the girl passes from adolescence to adulthood.
What is the impact of endometriosis on teenagers?
The impact of endometriosis on teenagers may be severe, with potential absenteeism from school during painful menstrual cycles, which may lead (at least in part) to social isolation and psychological disturbances.
What parents should know about endometriosis and what they should do to help their children?
Parents should know that the incidence of the disease is approximately 10% in women of reproductive age (which includes also adolescence), so they should seek consultation in referral centres for the management of endometriosis to confirm or exclude the diagnosis, whenever endometriosis is suspected (especially in case of severe dysmenorrhea).
Why, in general, teenagers are dismissed when they complain about period pain?
Usually this happens when adolescents (or their parents) refer to physicians who are not experts about endometriosis and so are not able to rule out or confirm the disease. This contributed, at least in part, to the old and wrong social stigma for which pain during menstruation should be considered normal.
What symptoms do we see in this age category?
The main symptoms of endometriosis in adolescent girls are chronic or acyclical pelvic pain, particularly combined with nausea, dysmenorrhoea, dyschezia, dysuria, dyspareunia.
Is the recurrence rate after surgery higher in teenagers than in older people?
To date there is no robust evidence suggesting that the recurrence rate after surgery is different in adolescents compared with older people. In both categories of age, the recurrence rate can be reduced using hormonal therapy after surgery (when it is possible).
What is the most safest, if this is possible, way of managing symptoms in teenagers?
In adolescents with severe dysmenorrhoea and/or endometriosis-associated pain, clinicians should prescribe hormonal contraceptives or progestogens as first-line hormonal therapy because they are effective and safe. In addition, non-steroidal anti-inflammatory drugs (NSAID) as a treatment for endometriosis-associated pain may be considered.
What sort of symptoms have and how can it be differentiated between other illnesses?
Endometriosis should enter in differential diagnosis with other causes of abdominal-pelvic pain, such as inflammatory bowel diseases (Crohn’s disease and ulcerative colitis), urological diseases (interstitial cystitis, often associated with endometriosis), as well as musculoskeletal pain. One of the main differences between pain caused by endometriosis and other conditions is that the first one is typical during the menstrual cycle (dysmenorrhea), at least in adolescents and early stages. If not treated, the disease can progress and the pain may become from cyclical to chronic: when pain becomes chronic (i.e. continue between a menstrual cycle and another one), it is more difficult to treat and often does not properly/completely respond to pharmacological/surgical approaches.
Where are we in terms of research for endometriosis in teenagers?
The main efforts in research about the topic is to find a non-invasive biomarker, or even better a combination of them, which can lead to diagnosis with great accuracy as soon as possible, allowing early treatment of the disease and avoiding its progression to advanced stages.