By Dr. Jennifer Dietrich, chief of pediatric and adolescent gynecology at Texas Children’s Hospital
In the most basic sense, endometriosis 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). 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.
Believe it or not, endometriosis affects not only adult women but also adolescent girls. The prevalence of the condition ranges between 4 and 17 percent worldwide among adolescents alone. Adolescents who have a first-degree relative with the condition have a higher predisposition toward development of the condition. Congenital reproductive tract abnormalities are just a few examples of types of reproductive tract problems associated with endometriosis; however, other types of reproductive tract problems are similarly associated with a high prevalence of associated endometriosis.
Symptoms to watch for include progressively worsening pain with periods and between periods. Among adolescents with chronic pelvic pain symptoms, it is estimated that nearly 40 percent 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 percent of cases.
There are several theories as to why endometriosis occurs. 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 an examination, blood tests or imaging studies alone. The only way to make the diagnosis definitively is surgically. At the time of surgery, the types of lesions and the 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 hormonal therapy. Educational information is available at endometriosisassn.org.