Q: What is endometriosis and when should I be concerned that my teen daughter might have this condition?

A: Endometriosis is a medical condition that occurs when tissue similar to the lining of a woman’s uterus can be found outside the uterine cavity. When endometrial tissue is found outside the uterine cavity it is called an endometrial implant. The majority of endometrial implants are located in the pelvis; for example, on the ovaries, on ligaments that support the uterus, in the area behind the uterus, or tissue covering the rectum and bladder. Endometrial implants can bleed in the same way the lining of the uterus does every month during a teenager’s period, which can cause pain.

Endometriosis can affect future fertility because endometrial implants can cause inflammation, which can result in scar-tissue formation in the fallopian tubes or distortion of the anatomy of the pelvic organs. Early diagnosis and treatment is important because it might protect a teen’s future fertility.

Signs your teen should see a doctor to identify whether endometriosis is likely include:

  • Uncontrollable cramps.
  • Cramping pain not eased by medication.
  • Generalized pelvic pain outside of her period.
  • Pain that causes missing school or extracurricular activities.

Endometriosis can be difficult to diagnose. There are no imaging tests such as X-ray, ultrasound, or MRI, or blood tests, to make the diagnosis. The only definitive way to diagnose endometriosis is with a procedure called a laparoscopy. Laparoscopy uses a special lens that allows a doctor to look inside a teen’s abdomen at her pelvic organs and evaluate whether endometriosis is present. At the time of surgery, visible endometriosis can be destroyed and sometimes pain will temporarily improve; however, it is not curative.

There is currently no cure for endometriosis. The goals in treating endometriosis are to prevent the disease from advancing by suppressing a teen’s period, provide symptomatic relief of pain, and protect future fertility.

NSAIDs and hormonal contraceptive methods can provide symptomatic relief. Birth control pills that contain estrogen and progesterone can be taken continuously to stop menstrual cycles, thereby improving symptoms, or progesterone medicine alone can be prescribed. Hormonal intrauterine devices (IUDs) are also an effective method for symptom management.

If pain is not improved, GnRH agonist medications temporarily shut off hormones made by the ovaries to stop menstrual cycles from occurring.

A doctor may refer a teen with endometriosis to a pain treatment program to provide physical therapy, biofeedback, or acupuncture. Lifestyle changes can help. Practicing mindfulness techniques and relaxation techniques such as yoga can ease pain. Exercising can often help ease menstrual cramps. Getting adequate sleep and eating a well-balanced diet are important, too.

Rachael L. Polis is a pediatric and adolescent gynecologist at Crozer-Keystone Health System.