Updates in Gynaecology

Edited by Dr Roman

DIAGNOSING ADOLESCENT ENDOMETRIOSIS

by Jose Roman

DIAGNOSING ADOLESCENT ENDOMETRIOSIS

How common are period pains in adolescents?

An Australian study of 1000 schoolgirls in Canberra aged 16-18 found that 93% had painful periods. Of these 21% had severe period pain and 26% missed school for period pain or a mix of period symptoms 

What type of pain deserves further investigations?

Mild discomfort on the first 1-2 days of a period is common and reasonable, especially if painkillers are effective. But, beware of the pain that:

  •     ✦Causes distress or inability to attend school or interferes with sport activities
  •     ✦It occurs after the first 2 days of the periods
  •     ✦It does not get better when using the pill or with painkillers (Braemar study showed that 95% of adolescents were using pain relief other than Paracetamol, in contrast to only 59% of non-adolescents)

 

If adolescents have pain that doesn’t respond to pain medications or the pill, how often do they have endometriosis?

70% will have endometriosis when diagnostic surgery is performed

What adolescents are at risk of endometriosis ?

  •     ✦Adolescents who have direct relatives ( mother, sisters) with endometriosis

(Braemar study revealed that 30% adolescents had a first-degree relative with endometriosis in contrast with 8% non-adolescents)

  •     ✦Adolescents who started with periods earlier ( American registry revealed nearly 40% women started experiencing period pains before 15 years of age )
  •     ✦Adolescents with low BMI

 

Can adolescents have grade 4 endometriosis ?

Yes. Braemar study reported 10% adolescents will have stage 4 disease.

Are a pelvic scan or serum CA125 useful for the diagnosis?

Only to reveal an endometrioma or deep infiltrating disease. So they will be negative most of the time. Serum CA125 is NOT useful for diagnosis.

60% adolescents with endometriosis have atypical red vascular lesions , which are only present in 20% adults.

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Adults are more likely to have black lesions

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