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Teenage Endometriosis – Your Questions answered

Endometriosis is the health condition in women where the cells that are identical to the lining of the uterus grow on unusual sites like the pelvic cavity. In the past, there was a common belief that endometriosis affected only older women but now we know that it is more common in young women. Although the actual cause and definite treatment of endometriosis in women is unknown, there are ways one can diagnose, prevent and manage the symptoms associated with endometriosis.

A lot of questions about teenage endometriosis crop up every now and then. Some of the common ones have been answered below.

Q1. Is severe period pain common in adolescents?

It is quite common. In fact there have been several observational studies that have been conducted like the Australian study where 1000 school girls between the ages of 16-18 years were studied and it was concluded that about 93% of them had painful periods. Of these 93%, 21% had severe period pain and about 26% missed school due to their pain symptoms.

Q2. What are the symptoms that teenagers suffer due to endometriosis?

There are several reasons for pelvic pain from endometriosis. Endometriosis responds to reproductive hormones like the lining of the womb. When women get their periods, the endometriosis tissue can breakdown and irritate the pelvic environment causing severe pain. The pelvic muscles can then respond by contracting and having muscle spasms (which causes pain). When the brain gets sensitised to the pain, severe headache and tiredness can occur. All these symptoms together can have a negative impact on the day-to-day activities and can hamper their general wellbeing. Also, this can have a direct impact on their emotional state (mood). Because of this the best approach to endometriosis is to use pain management methods that address all these aspects of pain.
Some other symptoms women with endometriosis can get include:
1. Heavy periods
2. Bloating
3. Lower back pain
4. Chronic pain throughout the cycle
5. Pelvic muscle spasm
6. An irritable bowel
7. A painful overactive bladder
8. Headaches
9. Fatigue

Q3. Which teenagers are at a higher risk of endometriosis?

Endometriosis has a tendency to run in the family. Young women who have relatives who suffer from endometriosis such as their mothers, aunts or sisters have a higher chance of having endometriosis.
In some cases, women are born with their reproductive tract shape that blocks the menstrual flow. Tis leads to the endometrial fluid and tissue to flow back into the pelvic cavity. This leads to endometriosis. About 50% women with this problem of their reproductive tract shaped this way suffer from endometriosis.

However, most girls who suffer from endometriosis have a normal shaped uterus.

Q4. What can adolescents with endometriosis pain do to manage their symptoms?

Girls who spend a lot of time resting find that their endometriosis pain worsens. It is better to maintain an active lifestyle rather than resting all day. This would help to reduce the pelvic spasm that is a common symptom in women who experience pain associated with endometriosis. You may just indulge in gentle exercises such as walking and stretching. Slight improvement in the diet can help relieve the bowel symptoms in girls suffering from endometriosis. Diets rich in fibre and drinking plenty of water is the most important aspect a girl should follow. Also, having a hobby or indulging in activities that help to deviate the mind from the pain associated with endometriosis is a good way to tackle the problem. Meditation also helps to keep the mind away from the pain symptoms. Hot water bath help to relax the pelvic region and can help with pain management.

Q5. What can parents and guardians do to help their teens to manage endometriosis pain?

Firstly, parents should make sure that they get good reliable information regarding endometriosis. Recognising the effects of the pain and how it affects your teen is of utmost importance. Empathising with your teen would help them feel better and more secure. Encouraging and making sure that your girl child goes to school, maintains a healthy lifestyle and maintains a good positive social network would make their life as better as possible. Parents should make sure that they try to shift the girls focus away from pain as much as possible. Support and help the teen to develop a plan to manage and withstand a bad pain day.

Q.6. Does the endometriosis pain disappear with age?

Although the symptoms of endometriosis are more troublesome and prevalent in younger women and women in the reproductive age, they don’t necessarily disappear or stop with age. Women who stop menstruating as well may suffer from symptoms and pain associated with endometriosis. Therefore management of the pain is of particular interest and there are several options available for women who suffer from endometriosis symptoms.

Q7. How else can the pain symptoms be managed in teenagers? Are there any alternatives?

Antioxidants alone or in combination, when given with known analgesics or independently have shown to decrease the free radical mediated nociception. Studies have demonstrated an inverse correlation between antioxidant intake and endometriosis pathology and an improvement in antioxidant markers upon supplementation of an antioxidant rich diet.

Curcumin is known as the best natural anti-inflammatory and anti-oxidant. Its action has been confirmed by a series of animal and human clinical trials. There is substantial evidence for the anti-inflammatory, antioxidant, anti-tumor, anti-angiogenesis, and anti-metastatic activities of curcumin. Curcumin has the ability of inhibiting endometriosis in vivo and may help in management of endometriosis by reducing estradiol production. It has also been found to inhibit the migration and invasion of endometrial carcinoma cells.

Resveratrol, a natural drug, induces apoptosis in endometrial stromal cells and has shown promising results. Resveratrol is a phytochemical found in high concentration in grapes, wine, tea, peanuts, and berries. It has demonstrated anti-inflammatory, anti-oxidative, anti-microbial, anti-atherogenic and anti-angiogenic properties.

N-acetylcysteine (NAC) is the acetylated form of the amino acid cysteine naturally present in some substances like garlic. It has demonstrated anti-proliferative action on cells of epithelial origin like endometrial cells in addition to anti-inflammatory and anti-oxidant action. It has been found to be effective in treating ovarian endometriosis.

References:
1. Ballweg, ML. Big picture of endometriosis helps provide guidance on approach to teens: comparative historical data show endo starting younger, is more severe. J Pediatr Adolesc Gynecol 2003; 16 (3 Suppl): S21-S26.
2. Parker MA, Sneddon AE, Arbon P. The menstrual disorders of teenagers (MDOT) study: determining typical menstrual patterns and menstrual disturbance in a large population-based study of Australian teenagers. Br J Obstet Gynaecol 2010; 117(2): 185-192.
3. Reese KA, Reddy S, Rock JA. Endometriosis in an adolescent population: the Emory experience. J Pediatr Adolesc Gynecol 1996; 10: 125-128.
4. Laufer MR, Goietein L, Bush M, Cranmer DW, Emans SJ. Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy. J Pediatr Adolesc Gynecol 1997; 10: 199-202.
5. Stefansson H, Geirsson RT, Steinthorsdottir V, Jonsson H, Manolescu A, Kong A, Ingadottir G, J. Gulcher J, K. Stefansson K. Genetic factors contribute to the risk of developing endometriosis. Hum Reprod 2002; 17(3): 555-9.
6. Shah DK, Correia KF, Vitonis AF, Missmer SA. Body size and endometriosis: results from 20 years of follow-up within the Nurses’ Health Study II prospective cohort. Hum Reprod. 2013 Jul; 28(7): 1783-92.
7. Ghonemy, Gehan Ebrahim, and Nadia Bassouni El Sharkawy. “Impact Of Changing Lifestyle On Endometriosis Related Pain”. IOSR Journal Of Nursing And Health Science, vol 06, no. 02, 2017, pp. 120-129. IOSR Journals, doi:10.9790/1959-060205120129.
8. Santanam, Nalini et al. “Antioxidant Supplementation Reduces Endometriosis-Related Pelvic Pain In Humans”. Translational Research, vol 161, no. 3, 2013, pp. 189-195. Elsevier BV, doi:10.1016/j.trsl.2012.05.001.