Adolescent endometriosis is a challenging condition to diagnose. Learn the role that ultrasound plays in early and accurate diagnosis.
With endometriosis, tissue similar to the uterine lining grows outside of the uterus, sometimes enveloping the ovaries, fallopian tubes, and other areas in the pelvis or abdomen. The specific prevalence of adolescent endometriosis is not known. However, the Endometriosis Association states that 6.5 million U.S. women and 89 million women worldwide have endometriosis and that it occurs in girls as young as eight. Early detection is important to manage and prevent or lessen long-term complications of this disease, which may include infertility.
Symptoms and Presentation of Adolescent Endometriosis
Common symptoms of endometriosis include period pain, pain during intercourse, and pain while defecating or urinating. A literature review published in Child notes that the clinical presentation of endometriosis in adolescents may include those common symptoms, but also atypical symptoms. Those less common symptoms include pain in the abdomen, pelvis, and lower back, as well as heavy periods, headaches, dizziness, and low energy. Symptoms also may occur outside the reproductive system, such as in the gastrointestinal and urinary systems. Additionally, Child described several studies that found a lag between the onset of endometriosis symptoms and diagnosis and described how that lag resulted in prolonged suffering, disease progression, and fertility impairment. One study the authors reviewed found that adolescents experienced pain for nearly two years and had been seen by three specialists before finally being diagnosed with the condition.
Why Early Diagnosis Matters
As a progressive illness, reducing the lag time between the appearance of symptoms and a diagnosis can help relieve unnecessary pain caused by the disease. Early diagnosis may also help preserve long-term fertility. While the disease does not cause infertility, endometriosis may make conception more difficult. The more severe the disease, the greater likelihood of fertility issues. What about this disease produces this negative impact on fertility? An opinion issued by a committee of the American Society for Reproductive Medicine (ASRM) notes that endometriosis can result in the following physical conditions that can negatively affect fertility:
- Distorted pelvic anatomy. Lesions and adhesions caused by endometriosis can impair ovary function and impair the release of oocytes
- Altered peritoneal fluid. People with endometriosis may have more peritoneal fluid than normal, and that fluid may contain elevated inflammatory cytokines
- Altered hormone function. Abnormal hormone function can alter how receptive the endometrium is to embryo implantation
- Reduced oocyte and embryo quality. Embryos from people with endometriosis develop more slowly and implantation success is lower
Adolescent patients may ultimately want to have biological children or keep that option available. If so, then early diagnosis and management are critical. The use of ultrasound can lead to more information and better treatment plans for patients.
Using Ultrasound for Adolescents with Endometriosis
An opinion published in Fertility and Sterility evaluated a study of 270 young women and the ultrasonographic presence of different forms of endometriosis. Researchers also evaluated the clinical symptoms in patients that prompted the use of ultrasound. They concluded that "ultrasound was a game changer" in altering what they called "the notoriously delayed diagnosis of endometriosis in adolescents." They noted that period pain is too often shrugged off as a rite of passage that young people must endure on their way to adulthood. Instead, the authors note, it should be viewed as a serious symptom and warning sign of endometriosis that should be investigated with ultrasound.
Science Direct5 published more detail about the Fertility and Sterility study, noting that period, pelvic, and abdominal pain were key markers indicating adolescent endometriosis. A goal of the study was to correlate that symptom with ultrasonographic findings. In study participants, they found that 20% with period pain, 33% with pain during urination or defecations, and 44% with gastrointestinal pain showed signs of endometriosis on their ultrasounds.
However, the study also noted limitations to the use of ultrasound on adolescents. Since this age group typically has a lower stage of disease with smaller lesions and superficial tissue invasion, ultrasound was not always able to detect disease. Ultrasound also was not able to diagnose superficial endometriosis of the peritoneum. In these cases, other imaging technologies and laparoscopy for endometriosis diagnosis and treatment may be the next step.
When Laparoscopy for Endometriosis Diagnosis May Be Needed
If pain persists but ultrasound cannot detect signs of the disease, escalating to laparoscopic imaging and surgery may be needed. With a lighted scope inserted through a small incision, a doctor may be better able to see growths, extract samples for analysis, and confirm the diagnosis. For other patients, combining ultrasound with laparoscopy may provide important information prior to surgery, helping physicians to find lesions and informing surgeons on how complex the surgery may be.
As a progressive condition, it's important to diagnose endometriosis as early as possible. Knowing you have the condition and being treated for it may improve quality of life, reduce the pain caused by the disease, and hopefully help preserve fertility for those who wish to have biological children.
