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The First Signs of Endometriosis in Young Women: Part One


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What is endometriosis?

Endometriosis is a disorder that occurs when tissue from the endometrium (the inner lining of the uterus) grows outside of the uterus. The tissue can spread to the ovaries, fallopian tubes, outer lining of the uterus, surrounding pelvic tissues, or even to the intestines. This endometrial tissue proceeds to act as if it was inside the uterus— thickening, breaking down, and sometimes bleeding. This can cause swelling and irritation which frequently results in pain, particularly throughout a menstrual cycle.

Endometriosis has the potential to affect women of any reproductive age, from their first period to menopause. Without treatment, endometriosis typically persists and worsens throughout the patient’s reproductive years.

At Mangrove Women’s Health, we offer specialty gynecology services and we are experienced in treating endometriosis in women of all ages. We supply our patients with expert care every step of the way, from diagnosis to treatment and follow-up care. Our goal is always to help our patients live fuller, more pain-free lives.

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How Is It Diagnosed?

The diagnosis of endometriosis should be considered if pelvic pain continues after treatment with medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives are prescribed to treat menstrual pain. According to Nationwide Children’s Hospital, up to 70% of young women whose pelvic pain doesn’t improve after implementing these medications have endometriosis.

The early stages of endometriosis cannot be accurately diagnosed with ultrasounds, MRIs, or blood tests. Physical exams can suggest the patient might have endometriosis but the standard way to give a concrete diagnosis is through a minimally invasive surgical procedure called laparoscopy. If the patient decides to get laparoscopic surgery, removal of the endometrial scar tissue can be done simultaneously.

Endometriosis is under-diagnosed in young women. This is in part because many doctors either don’t understand the condition or invalidate their patients because they don’t want to diagnose what they can’t treat. Additionally, the symptoms can also vary dramatically. Pain is usually a common symptom but it can also be difficult to diagnose because endometriosis often looks like something else. For example, some patient’s main symptoms could be bladder and yeast infections but another patient’s main symptoms could be vomiting/nausea presumably from pain.

Regrettably, many people aren’t aware that endometriosis can affect adolescent girls. This has led to patients often seeing five or more doctors before they even receive a diagnosis, with an average delay in diagnosis of 6.7 years. During this time, the patient can suffer physically and mentally from their condition without having the resources to improve their situation. Patients have been forced to take time off of work or school, and subsequently suffered from a decrease in their finances or grades. Patients have also reported strained relationships with family, peers, and intimate partners because of their delay in diagnosis.  

Endometriosis is difficult to diagnose.  It is incredibly beneficial to catch early in order to reduce the impact the diagnosis has on the patient’s quality of life. It’s important for young women and their parents to understand that extreme pain or bleeding is not normal. Particularly, if it’s so severe that it is interfering with the teen’s daily life like school, sports, or other activities. If your child comes to you complaining of severe pain, please bring them in for an appointment so we can make sure there is not an underlying condition causing their pain.

When do patients get diagnosed?

Patients typically suffer for a while before they come into the office. They don’t realize that while many women experience mild to moderate cramping, painful menstruation is not common. This is due in part because of the normalization of period pain and the stigma surrounding discussing menstruation.

Usually, it isn’t until symptoms persist or worsen significantly that young women are brought in for an appointment. Many of these young women experience their first pelvic exam during this appointment. 

Medical professionals who provide this exam must be very careful to ensure the patient isn’t caused any mental or physical distress. The patient must be treated with the utmost respect and care so their experience is as positive as possible. 

In young patients with endometriosis, everything may appear normal during the physical exam. That is why it’s essential to both educate and listen to the patient. If these symptoms persist, the patient may be prescribed pain medications (analgesics), NSAIDs, and/or hormonal contraceptives.

What Are the Risks?

Between 20-25% of patients are asymptomatic, however, long term problems can occur if endometriosis is not identified and properly treated early. If left untreated, endometriosis symptoms can potentially include:

  ●    Infertility

  ●    Chronic pain

  ●    Pain with sex

  ●    Premature birth

  ●    Pelvic adhesions

  ●    Future development of endometrial and/or ovarian cancer

Does endometriosis cause infertility?

Although endometriosis doesn’t inherently cause infertility, patients with this condition usually have more difficulty getting pregnant.  According to the American Journal of Obstetrics and Gynecology, about 30-50% of women with endometriosis are infertile, and 25-50% of infertile women have endometriosis. Endometriosis can cause inflammation which can lead to a number of reproductive system changes that increase the likelihood of infertility.

At Mangrove Women’s Health, our specialist team works to diagnose and treat endometriosis early to reduce the potential of infertility. Come back next week for part two where we will discuss the causes and treatment of endometriosis. 

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