Adolescent Endometriosis: Challenges and Considerations
As the average age at diagnosis gets lower, adolescent Endometriosis is becoming more mainstream. However, a great deal of education and awareness is still required to successfully manage the distinctive physical, psychological, and societal factors presented by the condition in teenagers.
In addition, treatment must be gentler and more measured to avoid unnecessary damage to still-growing bodies, especially regarding surgical and pharmaceutical interventions. Crucially, the psychological and emotional effects of Endometriosis can be severe. To counter this, offering support through family, peers, counseling services, and education can be useful for a patient’s mental health.
Research has estimated that more than a third of chronic pelvic pain cases in adolescents can be attributed to Endometriosis. However, symptoms are often mistaken for other conditions or simply overlooked. Some explanations for this phenomenon include a lack of gynaecological education and endometriosis resources within a community. Additionally, Endometriosis tends to present in more subtle ways in adolescent patients, as there has been less cumulative time for lesions to grow and migrate to other locations.
Collaborative Efforts
Adolescent endometriosis requires carefully considered multidisciplinary treatment. In contrast to treating adults, doctors are first and foremost discussing treatment options with an adolescent patient’s parents/guardians. Due to this, it’s essential for endometriosis specialists to effectively communicate the patient’s symptoms since the parents/guardians cannot experience them firsthand. Above all, an honest and healthy collaboration is required among the endometriosis team, guardians, and the patient.
Surgical Treatment
The range of options available for adolescents with endometriosis is limited across the board. Surgical interventions such as laparoscopy and excision surgery are commonly relied on for endometriosis treatment. However, surgery can be challenging in this age group as lesions are still developing. Therefore, the current medical opinion generally suggests delaying surgical intervention for stage 1 or 2 endometriosis until adulthood, as long as the patient can achieve relative stability via medications. Nevertheless, surgery is advisable if the quality of life is being significantly impacted, pharmaceutical measures are incompatible, or the patient has stage 3 or 4 endometriosis.
Hormonal Treatment
Hormonal treatment has been used to treat Endometriosis for decades. As an estrogen-dependent condition, symptoms can be mitigated by reducing the amount of estrogen within the body. However, this blockage of hormones during pubescence and post-pubescence can have long-term consequences. Therefore, pharmaceutical treatment pathways, which might otherwise be optimistic for their adult counterparts, must be meticulously considered by a patient and their guardians before proceeding. Progesterone-based medications and analgesics can be tried if symptoms and stage of the disease are not very severe, but in endometriosis, one size does not fit all. Hence, we need to tailor the treatment according to age, symptoms, and the extent of the disease.
Psychological Impacts
The mental health of adolescent patients must also be carefully considered. The inability to fully participate academically and socially can be devastating, especially to a young adult just beginning to step out into the world. Several studies, such as Sheng et al. (2017), have demonstrated the negative impact of chronic pain on an individual’s psychological state. These effects are multi-varied and cumulative, such as the effect of chronic pain on sleep quality, as demonstrated by Alhalal (2021). Poor sleep quality is injurious mentally and emotionally, but is also extremely unfavourable for physical health, especially for someone with a stress-influenced condition.
Support and validation from an individual’s inner circle, such as family and friends, can be crucial. Doctors also play a pivotal role in mitigating the brunt of the social isolation and emotional burden many of those with chronic illness experience.
Conclusion
To conclude, the unique challenges presented by Adolescent endometriosis must be carefully considered by all parties involved. Medical practitioners should be more prudent regarding surgical or hormonal care for younger patients. Additionally, the guardians play a pivotal role regarding their medical authority as well as their influence on their child’s emotional health. Crucially, psychological impacts should not be underestimated, and both guardians, peers, and medical practitioners must be prepared to offer support.
Sources:
Sieberg (Pelvic Pain Statistic)
https://www.uptodate.com/contents/endometriosis-in-adolescents-diagnosis-and-treatment#H28
https://www.sciencedirect.com/science/article/abs/pii/S1083318819303651
https://www.egojournal.eu/wp-content/uploads/journal/2020/2.2/77/77-81.pdf