Published: April 30, 2021 | Updated: April 19, 2022
Tessa Nielsen, 21, was in so much pain from her menstrual periods and cramps, she couldn’t do much at all.
“I would lie in bed, curled up in ball with a heating pad,” she said.
For months, her menstrual periods and cramps caused a stabbing pain she describes as being like a knife twisting around.
The periods also caused heavy bleeding, cramping, vision issues and nausea. She had a history of irregular periods, but this was something different. A laparoscopic surgical procedure diagnosed endometriosis.
“Endometriosis is most commonly diagnosed in patients 25 to 35,” said S. Paige Hertweck, M.D., pediatric and adolescent gynecologist treating patients to age 21 at Norton Children’s Gynecology, affiliated with the UofL School of Medicine. “But it can be diagnosed in adolescents.”
Endometriosis is caused when the uterine lining, the endometrium, grows beyond the uterus. It can be found on the outside of the uterus, ovaries, fallopian tubes and even in the pelvic cavity. These growths cause pain that can be severe, especially during menstruation. Other common symptoms of endometriosis include chronic pain in the lower back and pelvis, pain with intercourse and, especially during the menstrual period, pain going to the bathroom, diarrhea, constipation, bloating or nausea.
“Many young patients push severe pain to the side, thinking that it’s just a normal part of periods,” Dr. Hertweck said. “But it’s extremely important to talk to your medical provider to avoid issues in the future, including pain that gets worse, and infertility.”
Statistics show that 1 of every 10 people assigned female at birth who have gone through puberty have endometriosis. It is more likely to occur in those who have never been pregnant, when menstrual periods are longer than seven days, if menstrual cycles are under 27 days or if a family member has had endometriosis.
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For Tessa, who has at least one family member with diagnosed endometriosis, treatment included a high-hormonal intrauterine device (IUD) as well as medication to temporarily decrease her female hormone levels.
“I have finally started to feel like I have a normal life,” Tessa said. “I don’t have to worry about cramps or any of the issues I had before.”
“While endometriosis in teens is not as common, it’s important to have conversations with a provider early on about menstrual periods,” Dr. Hertweck said. “When we catch issues earlier, it has long-term health benefits.”
The American College of Obstetricians and Gynecologists recommends that young people who have started their periods have an initial well visit with a pediatric gynecologist to evaluate their current menstrual health. The visit often does not include a pelvic exam, unless there are strong reasons to indicate one is necessary.