High rates of pain and heavy bleeding found in teens with endometriosis
A study of adolescents with pathology-confirmed endometriosis reveals common symptoms such as progressive dysmenorrhea and heavy bleeding.
High rates of pain and heavy bleeding found in teens with endometriosis | Image Credit: © New Africa - © New Africa - stock.adobe.com.
Progressive dysmenorrhea, missed school or activities, and heavy menstrual bleeding are common in adolescent patients with pathology-proven endometriosis, with chosen treatment methods varying among this population, according to a recent study published in the Journal of Pediatric Adolescent Gynecology.1
Determining characteristics of endometriosis
The study was conducted to establish demographic characteristics and preoperative medical management methods used among patients aged less than 22 years with endometriosis confirmed through pathology. These patients received diagnostic laparoscopy from 1 of 8 Midwestern US tertiary care hospitals.1
Pathology records were assessed for demographics, medical history, clinical symptoms, and prior medical status. The final analysis included 305 patients aged a median of 15.6 years at first pediatric and adolescent gynecology (PAG) visit. Of these patients, 83.3% were White and 70.5% had commercial insurance.1
Participants were aged a median of 12 years at menarche, and a family history of endometriosis was reported in 45.3%.2 This involved first-degree relatives in 68.1% of cases. Additionally, a high rate of nonsteroidal anti-inflammatory drug use was reported, at 80.1%. In comparison, only 5.9% reported opioid use.
Common symptoms among adolescents
Endometriosis was diagnosed in only 4.3% of patients before their first PAG visit.1 Progressive dysmenorrhea was reported in 76.7% of these patients, heavy menstrual bleeding in 50.8%, and missed school or activities because of dysmenorrhea in 55.1%.
Beyond PAG, variations were reported in the providers whom patients sought to receive care for their symptoms. This included primary care by 75.1%, gastroenterology by 18.7%, adult gynecology by 22.3%, and physical therapy by 13.4%. Before laparoscopy, 92.8% of patients attempted oral hormonal menstrual suppression.1
Oral contraception was used for hormonal management by 62.3% of patients, medroxyprogesterone acetate injection by 15.7%, 5mg or less daily norethindrone by 14.8%, over 5mg daily norethindrone by 13.4%, hormonal intrauterine system by 13.1%, and contraceptive implant by 5.3%.1
Comorbidities and limitations
The presence of at least 1 comorbidity was reported in 73.4% of patients.2 Of the comorbidities, the most common in the study population was psychiatric disorders. Investigators noted selection bias and inconsistencies in data documentation as limitations of the data. Additionally, the study did not include assessments of clinical outcomes after surgery.1
Overall, the data highlighted a significant prevalence of progressive dysmenorrhea, missed school or activities, and heavy menstrual bleeding among patients with endometriosis.1 Variety was also reported in the providers whom patients sought care and in the method of care used.
“The findings underscore the need for early recognition, structured evaluation protocols, and consensus-based treatment algorithms in adolescent care,” wrote investigators.2
Mental health concerns
Alongside these common symptoms, data has also indicated increased mental health risks among patients with endometriosis.3 This association was reported in a systematic literature review of articles from the PubMed and Cochrane databases.
The data highlighted anxiety rates ranging from 10% to 87.5% among women with endometriosis, which is a significant increase from the rate of 6% in the general population. Endometriosis was also linked to increased rates of depression, at 9.8% to 98.5% in endometriosis patients vs 6.6% to 9.3% in controls.3
Symptomatic endometriosis patients also had an increased prevalence of depression vs asymptomatic patients. Overall, the data highlighted increased mental health burdens among endometriosis patients, further increased by pain.3
References
- Bergus KC, Rachwal B, Asti L, et al. Characteristics and preoperative management of adolescent patients with pathology-confirmed endometriosis: A multi-institutional study. J Pediatr Adolesc Gynecol. 2025. doi:10.1016/j.jpag.2025.04.003
- Clinical profiles of adolescents with histologically confirmed endometriosis. EndoNews. May 30, 2025. Accessed June 16, 2025. https://www.endonews.com/clinical-profiles-of-adolescents-with-histologically-confirmed-endometriosis.
- Krewson C. Addressing mental health risks in endometriosis patients. Contemporary OB/GYN. December 10, 2024. Accessed June 16, 2025. https://www.contemporaryobgyn.net/view/addressing-mental-health-risks-in-endometriosis-patients.
