Treating adolescent patients with dysmenorrhea is about more than just spotting the signs and symptoms of endometriosis.
Clinicians providing care for young patients with suspected endometriosis need a solid understanding of not only adolescent gynecology, but also child development and behavior. They must also provide a flexible treatment plan tailored to the tech-savvy young individuals of Generation Z.
Interpersonal skills that help clinicians engage and inform without judging or dictating are a distinct advantage when treating and fostering relationships with young patients.
From Dysmenorrhea to Suspicions of Endometriosis
Dysmenorrhea and irregular periods are the most common gynecologic complaints that bring an adolescent to the OB/GYN office or emergency room. Differential diagnoses may include ovarian torsion and pelvic inflammatory disease, or life-threatening conditions like ectopic pregnancy.
Urgent matters can be ruled out using a targeted physical exam, lab work and ultrasound. A precise diagnosis is not always necessary initially, as most young patients with dysmenorrhea can be treated with NSAIDs and hormonal therapy. However, some young patients will need to be guided toward an endometriosis treatment plan.
Outlining an Action Plan
Outlining a step-by-step action plan helps engage young people in their healthcare. Apps for tracking and recording pain and menstruation calendars are valuable resources the patient can use to document their response during treatment. Short-term follow up in three to four months allows a review of the symptom calendar, reinforcement of the need for compliance and a chance to make any necessary adjustments to the treatment plan.
Patients who have not responded to therapy will require further immediate evaluation. A significant number of these adolescents will ultimately be diagnosed with endometriosis. If is has not been completed already, imaging should be considered at this stage. Even if there are no classic ultrasound findings of endometriosis, such as bilateral endometriomas, laparoscopy for diagnosis and operative management is the next step.
Signs and Symptoms of Endometriosis in Adolescents
Laparoscopic findings may be quite subtle in adolescents. Familiarity with the full spectrum of endometriosis appearances is helpful, as is a systematic approach in evaluating the pelvis.
The muted lesions often encountered in adolescents are more easily visualized if irrigation fluid is placed in the pelvis, according to research published in Human Reproduction. Using a spiral or clockwise inspection, start anteriorly at the bladder peritoneum and work in concentrically smaller circles. Begin along the pelvic brim, then lower along the sidewalls, and finally deep along the pelvic floor.
The current theory is that endometriosis is a progressive disease that advances through various stages with powder burn lesions and Allen-Masters type peritoneal pockets, the end result of progressive endometriosis. In adolescents, clear vesicles on the peritoneum, red lesions and flame lesions are more commonly seen.
Treating Adolescent Patients Holistically
Adolescence is a critical period of rapid physical growth and the development of emotional maturity. Some teenagers achieve global success advocating for issues such as equal access to education, climate change and the availability of tax-free sanitary napkins for students so their education is not interrupted during their menses. However, the majority of adolescents are simply juggling the daily life stressors of fitting in, completing their studies and getting along with friends, siblings and parents.
The transition to adulthood can be charged with intense emotions and imperfect judgment. But ignoring problems like endometriosis along the way can complicate an already tumultuous time and have a negative impact on an adolescent's future health. Young adulthood is a matchless opportunity to launch strong, trusting physician-patient relationships.
Understanding the medical needs of adolescents and responding to them appropriately is a critical first step in building a healthy foundation for their lifetime.
