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Pain ‘down there?’ It could be endometriosis

Even if you are still in your teens, says Dr. Judith Reichman, don’t delay in seeking help for severe pain in the pelvic area.

Q: My daughter is 17. Ever since she first got her period, she’s had horrendous pain. Could she have endometriosis?

A: Yes, she could. Although endometriosis is usually diagnosed between the ages of 25 and 30, data from the Endometriosis Association show that 66 percent of adult women reported the onset of pelvic symptoms before 20 years of age, and 40 percent of those women have been to the doctor more than five times a before receiving the correct diagnosis of endometriosis.

When is it time to visit the doctor?A diagnosis of endometriosis in your daughter’s case may be warranted if she feels that her cramps and pelvic pain are becoming progressively worse, and if the pain comes at times other than when she has her period (which is called acyclic). Because severe pain among young girls can interfere with school, sports and psychosocial development, it is especially important that an appropriate diagnosis be made in a timely fashion — not after she’s seen more than five doctors!

What is endometriosis?Endometriosis is where tissue similar to the uterus’ lining is found elsewhere in the body. This may occur in the pelvic cavity, including on the ovaries, the fallopian tubes, the pelvic sidewall, in C-section scars, on the bladder or other areas. The most common symptom is pelvic pain that correlates with the menstrual cycle. This occurs when the endometriotic tissue, reacting to the hormones released in the menstrual cycle in the same way as the lining of the uterus, bleeds and/or irritates adjacent organs.

How do you diagnosis endometriosis? And what are the treatments?When I see a young patient who complains of pelvic pain, my diagnostic preference is to perform a pelvic exam to rule out ovarian cysts or masses. However, if the young woman is not yet sexually active and feels uncomfortable with this, I order an ultrasound (done with an abdominal transducer) or even an MRI. Unfortunately, small implants of endometriotic tissue, may not necessarily be “seen” in ultrasound.

My next approach would be to empirically try both birth control pills (to suppress ovulation) and non-steroidal anti-inflammatory drugs (NSAID’s) to try to control the pain. If these treatments are not successful, I might consider giving something called GnRH agonists to halt ovarian production of hormones and stop periods. (GnRH agonists are drugs that stop the production of estrogen.) If the pain subsides, I can make the diagnosis of endometriosis.

(It is important to note that this last therapy should be used with extreme caution for more than six months. Because the treatment stops estrogen production, it can also influence bone formation and lead to low bone density. To diminish this risk, doctors often use feedback therapy and prescribe low doses of progestin or a combination of estrogen and progestin. This doesn’t seem to block the efficacy of the therapy but does help to reduce hot flashes and other menopausal type symptoms.)

The last resortAs a last resort, especially in young patients who continue to have pain or who have problems tolerating these medical therapies, surgery to remove or destroy the abnormal tissue may be necessary. Usually, this can be done through a laparoscopic procedure. Since endometriosis is, unfortunately, an ongoing disorder, I would suggest, even after surgery, that the patient continue taking birth control pills to suppress ovulation and “discourage” new endometriotic cell formation. She should, of course, stop when she is ready to conceive. The patient may also need ongoing pain management support.

Dr. Reichman’s Bottom Line: If your daughter’s pain gets worse, make sure she sees a gynecologist to assess the possibility of endometriosis. She need not suffer; there are ways and means to help control the woes of this disease.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.