Anne had never had problems with her periods the way some of her
friends did. But over time her periods started getting so painful
that she dreaded their arrival. Every month for a few days she
would curl up on the couch with a heating pad and take a pain
reliever. The cramps eventually became so bad that she was missing
school a couple of days a month, and the pain even started
happening between periods.
Anne's doctor thought Anne might have endometriosis. So she
referred her to a specialist in treating this condition.
What Is Endometriosis?
When a woman has endometriosis, tissue that looks and acts like
the lining of the uterus starts growing
the uterus. The most common locations for these growths - called
- are the outside surface of the uterus, the ovaries, the fallopian
tubes, the ligaments that support the uterus, the intestines, the
bladder, the internal area between the vagina and rectum, and the
lining of the pelvic cavity.
Endometriosis affects more than 5 million American women,
including teen girls. It's not always diagnosed right away in
teens because at first they or their doctors assume that their
painful periods are a normal part of menstruating. But continuing,
excessive pain that limits activity isn't normal and should
always be taken seriously. Because severe endometriosis can make it
complicated for a girl to have children in the future, it's a
good idea to get medical help for endometriosis and not wait too
To understand why endometriosis causes problems, it helps to
have a basic understanding of how the monthly menstrual cycle
works: During the course of each cycle, the lining of a woman's
uterus builds up with blood vessels and tissue. This happens
because the uterus is getting ready to receive the egg that will be
released from one of the ovaries. If the egg isn't fertilized
by sperm, the uterus sheds the tissue and blood; this is the
menstrual period. This entire process is controlled by the female
sex hormones and usually takes about 28 to 30 days.
Because the abnormal growths associated with endometriosis are
made up of the same kind of tissue and blood vessels found in the
uterine lining, any endometrial implants will act just like the
endometrium in the uterus. That means they respond in the same way
to the hormonal changes of the menstrual cycle.
However, in the uterus, if the egg isn't fertilized, the
extra tissue and blood leave a girl's body in the form of
menstrual fluid. With endometriosis, though, there's nowhere
for the accumulating blood and tissue to go once the implants start
to break down. For this reason, the implants usually become
somewhat larger with each cycle, and the symptoms of endometriosis
tend to become more painful over time.
What Causes Endometriosis?
Doctors aren't sure what causes endometriosis. They do know
that it is slightly more common in teens and women who have a
family member who has been diagnosed with endometriosis.
There are several theories about how the endometrial tissue
actually gets outside the uterus in the first place. One theory
suggests that the menstrual blood flow somehow "backs up"
into the fallopian tubes, carrying some tissue from the uterine
lining with it. In effect, the tissue gets transplanted and starts
growing outside the uterus.
Another theory is that endometrial tissue cells travel out of
the uterus through blood or lymph vessels, and then start growing
in the new locations where they're deposited. Yet another
theory suggests that some girls are born with "misplaced"
cells that can turn into endometrial implants later in life.
Scientists continue to research the condition to help doctors fully
understand and treat it.
What Are the Signs and Symptoms?
The most common sign of endometriosis is severe pelvic (lower
abdominal) pain. It may occur occasionally or constantly, and it
may be associated with a girl's period. Although slight cramps
for a couple of days before or during a menstrual period are
normal, lasting or intense pain that disrupts a person's day is
not. With endometriosis, the pain is usually so bad that it causes
a girl to miss school, sports, and social activities.
Other possible symptoms include:
- pelvic pain that gets worse after sex, or after a pelvic
- a very heavy period
- lower back pain
- constipation, diarrhea, or feeling pain or seeing blood when
going to the bathroom (endometrial implants can press on some of
the organs involved in getting waste out of the body, such as the
bladder, intestines, and rectum)
If a girl notices these symptoms, it doesn't necessarily
mean that she has endometriosis. Lots of other things - like an
infection - may cause similar symptoms. But it's important to
see a doctor right away if you notice these symptoms. If you
haven't been examined by a
for the first time yet, this is a good time.
How Is It Diagnosed?
Diagnosing endometriosis isn't always easy. Lots of things
can cause pelvic pain, so even if a girl's symptoms point to
endometriosis, a doctor may want to rule out other
In addition to doing a
, the doctor will ask you about any concerns and symptoms you have,
your past health, your family's health, any medications
you're taking, any allergies you may have, and other issues.
This is called the
. Depending on your symptoms, a doctor may also ask you to keep a
pain diary. This may involve recording the following information
every time you experience pain:
- type of pain (is it sharp? dull? aching? crampy?)
- location (where is it?)
- duration (how long does it last?)
- intensity (on a scale of 1 to 10, how bad is the pain?)
- treatment (did you try anything to make the pain go away? did
The severity of the pain isn't always an indicator of how
severe the endometriosis might be. A girl may have many growths and
just a little pain or a few growths and a great deal of pain. Every
person's situation is a little bit different.
The only way to know for certain whether a girl has
endometriosis is to perform a minor surgical procedure called
-kuh-pee). This allows the doctor to know for certain whether a
girl has endometrial implants and, if so, how extensive they
While a girl is under anesthesia, the doctor makes a small cut
near her belly button and inserts a thin, lighted tube (known as a
laparoscope) that acts as a tiny video camera so that the doctor
can view the pelvic organs. During the procedure, the abdomen is
filled with a gas to help the doctor see the organs better. The
doctor may also do a
, which means removing small pieces of the growths for examination
under a microscope.
Even if a girl's symptoms point to endometriosis, a doctor
may not want to perform a laparoscopy right away. He or she may
first order scanning tests that can create images of the pelvic
region, such as ultrasound or magnetic resonance imaging (MRI).
This helps to rule out other possible causes of the symptoms.
Doctors may also start by telling a girl to take acetaminophen or
ibuprofen. Some doctors will prescribe birth control pills, not as
a method of contraception but because they have been proven to
reduce painful periods, especially those associated with
If these approaches don't work, and the doctor thinks a girl
has endometriosis, then he or she will probably order the
What Do Doctors Do?
Endometriosis can't be cured, but its symptoms can usually
Doctors often prescribe birth control pills because they use
hormones to prevent ovulation (the monthly release of an egg
from an ovary). If a girl doesn't ovulate, then the endometrial
implants won't build up as much, and this can make
endometriosis less painful.
Other medications used to treat endometriosis work in the same
way as birth control pills to modify the hormone-driven buildup and
breakdown of endometrial tissue. Doctors typically don't
recommend these treatments for teens until well after
is completed, though.
Surgery is often helpful if medications don't work. A
doctor can remove endometrial growths by directing an intense light
beam (laser) onto them with the help of a laparoscope. After this
treatment, many girls find relief from their symptoms, but some may
experience pain again if the growths return over time. Laparoscopic
treatment is the typical type of surgical treatment for
endometriosis, although in rare cases more extensive surgery may be
Doctors often suggest lifestyle changes for teens who have
endometriosis, too. A healthy diet, moderate exercise, and
relaxation techniques such as yoga and meditation can help.
What's It Like to Have Endometriosis?
Apart from the pain, there are other things that can make living
with endometriosis a challenge for some girls. Some girls find it
difficult explaining to friends and teachers why they miss school,
sports, or other activities, for example. If you feel embarrassed,
ask your doctor to write a note you can give to teachers and
coaches so you don't have to explain yourself. You can then
work with them to be sure you don't miss out on key assignments
- or fun.
You don't have to go into detail about your condition to
friends or classmates unless you want to. If you think someone
won't understand, just tell that person you're not feeling
well. You have no obligation to provide them with a detailed
These days, more and more doctors recognize and understand
endometriosis. Many girls find that medication limits the extent of
their endometriosis. It also controls pain so girls with
endometriosis can take part in the activities they enjoy.
Larissa Hirsch, MD
Date reviewed: April 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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