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Endometriosis in Teens
What is endometriosis?
Endometriosis is a
condition that occurs when tissue similar to the lining of the
uterus is found outside its normal location. Common locations of
endometrial implants include the ovaries, fallopian tubes, and ligaments that support
the uterus and tissue covering the
bladder
and rectum.
The location of the endometrial implants and the way in which the
lesions affect the pelvic organs contribute to the symptoms
adolescent and adult women may have. Some teens have a lot of
endometriosis and have very little pain, while others who have a
small amount of endometriosis have severe pain. While we don't
know what causes endometriosis, we do know the pain experienced by
teens is very real.
What are the symptoms of
endometriosis?
Endometriosis causes different
symptoms in young women. Occasional or constant
pelvic pain and/or severe period cramps are definitely the
most common symptoms. There can be pain before, during or after
your period. The pain may occur at regular times in your cycle or
the pain may occur at any time during the month. It is often
referred to as "chronic"
pelvic pain. Some teens may have pain with exercise, sex, and/or
after a pelvic exam. Painful or frequent
urination, diarrhea or constipation may accompany the pelvic
pain.
How is endometriosis diagnosed?
If you have unexplained
pelvic pain, menstrual cramps that are so bad that you miss school, or pain
when you have sex, you could have endometriosis. There could be
other reasons for your symptoms too. Only your health care
provider can tell for sure. In fact, the ONLY way to be 100%
certain of this diagnosis is to have a procedure called a
laparoscopy.
A laparoscopy allows your doctor to look inside your belly at your
pelvic organs with a special lens to identify the endometriosis
(implants). Other tests that MAY be ordered by your health care
provider BEFORE a laparoscopy might include blood tests, cultures
to check for infection,
ultrasound or an MRI (to make sure it's not something else).
If you think you could have endometriosis, you will want to find a
qualified gynaecologist
to evaluate you.
What causes endometriosis?
Although we know that some young
women may be slightly more likely to develop endometriosis because
female relatives have it, the truth is we do not know the cause of
this disease. The three most accepted theories are:
-
Sampson's Theory:
This theory explains that the flow of menstrual blood gets "backed
up" causing some of the blood to flow in a reverse direction. This
process causes blood containing endometrial tissue to attach to
surfaces outside of the uterus.
-
Meyer's Theory:
This theory proposes that specific cells called "metaplastic
cells" change into
endometrial cells
and are actually present at birth.
-
Vascular Theory: This
theory suggests that the
endometrial tissue "travels" through the body via blood
vessels. It then reaches various tissues, implants, and then
grows, causing pain.
What can I do if I think I might have
endometriosis?
While we can't cure endometriosis,
you can be treated for your symptoms. If you are having pelvic
pain or unexplained period cramps which cause you to be absent
from school several days a month, you may want to keep a record of
your symptoms. You can also identify your pain by writing a pain
diary. Ways to help you describe your pain:
-
Type
(sharp, dull, burning, aching, crampy)
-
Location (where is
the pain?)
-
Duration
(how long does it last?)
-
Intensity
(scale of 1-10, how "bad" is the pain?)
Next, talk to your gynecologist about
your symptoms and bring your pain diary with you for your doctor
to review. It's a good idea to bring copies of test results,
operative notes (a summary by your doctor if you have had surgery)
and/or radiology reports (you can ask for copies of these too from
the x-ray department of the health care facility where you had
your ultrasound or x-ray). Most importantly, make sure you are
evaluated by a gynecologist who specializes in taking care of
teens with endometriosis. A research study done at Children's
Hospital in Boston found that endometriosis was the most common
diagnosis after surgery in teens who had chronic pelvic pain.
What kinds of treatment are
available?
Talk to your gynecologist about
treatment options. When an evaluation by your gynecologist
suggests endometriosis, it is likely that you will be scheduled
for a diagnostic laparoscopy. Once a definitive diagnosis of
endometriosis has been made, treatment falls into the following
categories.
-
Observation
After a complete evaluation and before beginning therapy, you and
your health care provider may decide to keep track of your
symptoms and try mild pain medicine.
-
Medical
suppression
Hormonal treatment such as birth control pills either taken in
cycles or continuously are felt to relieve symptoms in 8 out of 10
patients. Another medication is a
GnRH agonist, such as Lupron, works by shutting off hormones
made by the ovaries and temporarily stopping your period. The use
of GnRH agonist therapy lowers your body's estrogen level (one of
the hormones that causes your body to have periods). This medicine
has been approved by the Food and Drug Administration to be used
for 6 months at a time. If used for over 6 months, studies have
found it can cause changes in bone density.
-
Surgery
Using a special instrument at the time of the laparoscopy, your
doctor lasers or cauterizes the endometriosis. After going through
this procedure, many teens find relief from symptoms but some
teens over time may experience pain again.
-
Lifestyle changes
Dealing with chronic pelvic pain can be challenging. Exercise
often helps to relieve or lessen pelvic pain and menstrual cramps.
Eating well and getting enough rest also helps the body to manage
pain. Practicing relaxation techniques such as yoga and meditation
help to ease pain too.
-
Pain
Treatment Services
Many centers work closely with other health care providers in
programs that provide treatment and support for acute and chronic
pain. Following an evaluation, services such as biofeedback,
physical therapy, TENS (transcutaneous electrical stimulation) and
exercise programs may be offered.
-
Complementary medicine
Acupuncture, herbal remedies, homeopathy and healing touch are
among popular "alternative approaches" to medical treatment. Many
of these therapies can be helpful, however, not every alternative
approach has been proven to be safe and effective. Research
studies are limited. Before experimenting with any alternative
therapy, check with your doctor.
What else do I need to know about
endometriosis?
-
Young women
CAN suffer from symptoms of endometriosis. Medical studies have
found this disease in teenagers and young children.
-
Endometriosis is NOT an STD (sexually transmitted disease).
-
Chronic
pelvic pain is not normal. Most young women have none or mild to
moderate menstrual cramps one or two days a month. If you are
absent from school excessively due to pelvic pain or menstrual
cramps, consult your health care provider.
-
Endometriosis occurs among women of ALL races.
-
Getting
pregnant does NOT cure this disease but may improve symptoms for
some women. Some women with endometriosis who have had children
continue to have pain.
The goal of the treatment should be
aimed at relieving pain, controlling the progression of the
endometriosis and preserving fertility for future childbearing.
Treatment can make a big difference in improving the quality of
your life. Medical science is constantly moving ahead. Ask your
health care provider about more information about teens with
endometriosis. |
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