Endometriosis: Teenage Years
👩⚕️ Why Teen Endometriosis Is Often Missed
Teenagers do not always present with the “classic” adult description of endometriosis.
Symptoms are often:
- minimised
- normalised
- mislabelled as something else
This can lead to early missed opportunities for recognition and treatment.
🚨 Key Point
👉 Teenagers often present with “recurrent UTIs”
But commonly:
- urine cultures are negative
- symptoms keep recurring
- antibiotics do not fully solve the problem
ie there are clues...
What may actually be happening:
- bladder irritation from adjacent inflammation
- pelvic floor tension
- early endometriosis
Other Common Teen Symptoms/Experiences:
- severe dysmenorrhoea
- periods causing school absence
- nausea or vomiting with periods
- IBS-type symptoms
- bloating
- fatigue
- pelvic pain outside of periods
- bladder urgency or frequency
- pain that seems “out of proportion” to what is expected
- the pill 'not working'
🧠 Why Early Recognition Matters in Teens
Early recognition matters because delayed treatment can contribute to:
- worsening pain pathways
- pelvic floor guarding
- central sensitisation
- disruption to education, sport, sleep, and social development
My Key Take Home Message
👉 You do not need laparoscopy to begin treatment in a teenager with a convincing clinical picture
Treatment can begin based on:
- symptom pattern
- severity
- cyclical nature
- exclusion of other urgent pathology
- Teen Management Principles
- take pain seriously
- do not normalise school-disrupting symptoms
- think broadly across bladder, bowel, and pelvic symptoms
- treat early to reduce long-term pain amplification
remember that hormonal treatment is often both diagnostic and therapeutic
First-line Management in Teenagers
Hormonal suppression
This is usually the starting point - it is not a 'plaster' -> but a diagnostic trial.
Options often include:
- continuous COCP
- progestogen-only pill such as Slinda or Cerazette
- Mirena in selected cases
- norethisterone or other progestogen support where appropriate
Why it helps:
- suppresses ovulation
- reduces hormonal stimulation of lesions
- decreases cyclical inflammatory flares
- may prevent pain progression
Other Important Supports in Teens
Treatment may also need to include:
- pelvic floor physiotherapy if muscle tension is present
- pain education
- nervous system support
- support around sleep, school attendance, and functional impact
- validation that symptoms are real and worthy of treatment
⚠️ Special Clinical Insight in Teenagers
Teenagers are often told:
“period pain is normal”
“your tests are fine”
“it’s probably just stress”
But severe pain, repeated bladder symptoms, vomiting with periods, or missing school are all signs to think more carefully.
Key Message
think endometriosis early in teenagers
recurrent “UTIs” with negative cultures should prompt broader thinking
severe period pain is not something to dismiss
empirical hormonal treatment is appropriate and often helpful
early support may reduce later chronic pain, school disruption, and diagnostic delay
