Does Endometriosis Occur In Adolescents?

In the most basic sense, endometrosis is defined as the presence of endometrial glands and stromal tissue outside the uterine location (pelvic and abdominal visceral surface lining and pelvic or abdominal organ surfaces) (Figure 1). Over time, the presence of these glands and stromal tissue outside the endometrial lining of the uterus may result in adhesions, scarring, infertility, endometriomas of the ovary and/or adenomyosis of the uterine wall.

Figure 1

endometriosis-diagram-uterus

Believe it or not, endometriosis affects adult women and adolescent girls. The prevalence of the condition varies between 4-17% worldwide among adolescents alone. Adolescents with a first-degree relative with the condition have a higher predisposition toward development as well. In addition, congenital reproductive tract abnormalities (Figures 2 and 3 are just a few examples of types of reproductive tract problems associated with endometriosis, but other types of reproductive tract problems may also be associated) are associated with a higher prevalence of associated endometriosis.

Figure 2

didelphic-uterus

Figure 3

bicormuate-uterus
Symptoms include progressively worsening pain with periods and between periods. Among adolescents with chronic pelvic pain symptoms, it is estimated that nearly 40% may have endometriosis as the underlying cause. Interestingly, among adolescents undergoing indicated laparoscopy for unexplained chronic pelvic pain, endometriosis may be found in up to 70% of cases according to experts.

There are several theories as to why endometriosis may occur. The most commonly discussed theory is that of retrograde menstruation. This means menstrual blood may flow backwards from the fallopian tubes into the pelvis or abdomen in addition to having menstrual flow from the typical location of the vagina. Other theories focus on the possibility of autoimmune processes, embryologic cell rest transformation, movement of abnormal cells through the bloodstream or lymphatic system or even environmental exposures. Unfortunately, no single theory completely accounts for all cases of endometriosis, therefore, most experts now believe the process is multifactorial.

The diagnosis of endometriosis cannot be definitely made with examination, blood tests or imaging studies alone. The only way in which to make the diagnosis definitively is surgically. At the time of surgery, the types of lesions and location of the lesions is recorded to determine the extent of the disease. Once a diagnosis is made, there are a number of treatment options available to adolescents, including depot medroxyprogesterone injections, depot leuprolide injections or continuous combined hormal therapy. Educational information is available at endometriosisassn.org.

A list of various conditions seen may be viewed on the Texas Children’s Hospital website {link to problems seen and age group}

To learn more about this service, please visit our Pediatric and Adolescent Gynecology web page.

About Dr. Jennifer Dietrich, Chief of Pediatric and Adolescent Gynecology

I am the Division Director for Pediatric and Adolescent Gynecology at Baylor College of Medicine and Chief of Pediatric and Adolescent Gynecology at Texas Children’s Hospital.

My research interests include congenital problems of the reproductive tract, disorders of sexual differentiation, disorders of puberty, hormonal imbalance, pelvic masses and bleeding disorders in young women.

Posted in Adolescent Medicine, Obstetrics and Gynecology, Parenting, Pavilion for Women

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