Do Adolescents and Adults Experience Endometriosis Differently?

Symptoms may differ depending on the age of a woman when she was diagnosed with endometriosis.

Key Points

Highlights:

• Although symptoms of endometriosis seem to be the same among women regardless of the age of diagnosis, adolescents have more nausea and symptom onset at their first period compared to adults. 

Importance:

• An understanding of whether there is a difference between symptoms experienced by adolescents and adults may shorten the time it takes for the condition to be diagnosed.

Key results:

• All participants had non-cyclic, general pelvic pain that had a negative impact on their quality of life regardless of age.
• 90% of participants experienced moderate to severe menstrual pain irrespective of age.
• An average of 3 doctors was seen by women before being diagnosed with endometriosis.
• The average time from symptom onset to diagnosis was shorter for adolescents compared to adults (2 vs. 5 years).
• Pelvic pain started with the first period in 50% of adolescents and 33% of adults
• 69% of adolescent and 53% of adults said they had nausea accompanying pain.

Limitations of the study:

• The increasing knowledge about endometriosis in general medical practice may affect the time to diagnosis.
• The increasing knowledge about endometriosis in general population may affect the awareness of the symptoms.
• Participants were enrolled from only two centers, which may skew the results. Similar multi-center studies are needed to confirm these findings.

Lay Summary

Symptoms of endometriosis seem to be the same between women surgically diagnosed during adolescence and those diagnosed as adults, according to a study published in the American Journal of Obstetrics and Gynecology. For both age groups, pelvic pain was severe, non-cyclical, and negatively impacted the quality of life, but adolescents had more nausea and symptom onset at their first period. 

“Clinicians should be aware of these alternate symptom patterns, and include endometriosis in their differential diagnosis for both adolescent and young adult women experiencing non-cyclic pelvic pain and nausea,” wrote Dr. Amy Desrochers DiVasta and the co-authors of the study.

To date, it was not clear whether symptoms of endometriosis experienced by adolescents differed from adults.  Researchers led by Dr. Stacey Missmer at Boston Children’s Hospital and Brigham and Women's Hospital, recruited 295 adolescents and 107 adult patients (diagnosed older than 18) with surgically confirmed endometriosis enrolled in The Women's Health Study: From Adolescence to Adulthood, to determine the age-related differences at the time of surgical diagnosis. They also evaluated whether the question above could impact the time to diagnosis,

All women completed an expanded version of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project (WERF EPHect) standard clinical questionnaire. The questionnaire included questions about menstrual history and associated pain.

The results showed that 90 percent of participants experienced moderate to severe menstrual pain. 

On average, women saw three doctors before being diagnosed with endometriosis regardless of their age. However the time it took for women to be diagnosed with endometriosis from when their symptoms first appeared differed and were two years on average for adolescents and five years for adults. 

Half of the adolescents said their pelvic pain started with their first period while only a third of adults reported this. Similarly, the incidence of nausea accompanied by pain was higher among adolescents with 69 percent reporting this, compared to 53 percent of adults. 

All women reported non-cyclic, general pelvic pain that interfered with their work or school, daily activities, exercise, and sleep. Half of the women said that this pain went away after a bowel movement. 

Although the symptoms of endometriosis did not seem to differ between adolescents and adults, subtle differences exist that may have an impact on the time to diagnosis from symptom onset.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29247637