“Stealing the best years”: doctors are alarmed by the spread of endometriosis among teenagers

The disease is a mystery

According to the latest WHO data, about 176 million women worldwide suffer from endometriosis today. One in 11 women suffers from endometriosis during their reproductive years. Despite the fact that endometriosis is one of the most common diseases among women, women themselves are least aware of it. According to international studies, about 80% of the fair sex do not know that pain in the lower abdomen and lower back, painful discharge during menstruation is not the norm, but a symptom of a serious illness. However, as experts say, the real statistics on the prevalence of this pathology of the female reproductive system is much higher. Many women spend seven to twelve years visiting various specialists and undergoing examinations before hearing from a doctor about this serious diagnosis.

Endometriosis is an inflammatory disease in which the cells of the inner layer of the uterus (tissue similar to the endometrium) grow beyond its boundaries, that is, into the peritoneum, fallopian tubes, and ovaries. We can guess that women have faced this problem at all times. However, the first documented description of the disease was made only in 1860. Its author is the Austrian doctor Karl von Rokitansky, who worked at the Department of Pathanatomy of the University of Vienna. It was he who was the first to see under a microscope the endometrial glands and stroma in the tissues of a woman’s reproductive system.

Science does not know the exact reasons for the development of endometriosis, there are only assumptions. Among the reasons, for example, are heredity, hormonal disorders, infections, disorders of the immune system, pathological childbirth and abortion… There is a theory that autoimmune processes underlie the development of the disease. Some researchers suggest that endometrial cells spread throughout the body through the circulatory or lymphatic systems. One of the most interesting theories is dysontogenetic. She suggests that endometriosis develops due to disturbances in the embryonic development of the fetus, or more precisely, from particles of embryonic material responsible for the formation of the female genital organs and endometrium. Stress and psychological stress can contribute to the formation of the disease: it has been noted that very often active and busy women suffer from endometriosis. Moreover, the disease does not depend on nationality, social status and lifestyle.

As Mekan Orazov, professor of the Department of Obstetrics and Gynecology with a course in perinatology at RUDN, says, today endometriosis is recognized as a potentially incurable disease: “And we remember that the most terrible diseases are not fatal, but incurable. We are seeing a dramatic increase in adolescent endometriosis, with prevalence ranging from 25% to 38.3% among adolescents with chronic pelvic pain, while the incidence of asymptomatic endometriosis remains unknown. Endometriosis is diagnosed in 80% of women with unexplained infertility. At the same time, the disease does not go away even in postmenopause.”

And although the main symptom of the disease is pelvic pain, non-specific manifestations are often encountered. For example, a study conducted this year among 7,606 patients showed that with endometriosis, women are often bothered by back pain, headaches, and joint pain. In addition, according to this study, patients with endometriosis are more likely to have allergies, sleep disorders, extreme fatigue and palpitations. Other studies show that endometriosis is associated with an increased risk of depression, eating disorders, irritable bowel syndrome and anxiety.

One of the most serious consequences of endometriosis is infertility. About 40% of women of reproductive age suffering from endometriosis experience problems conceiving. In addition, endometriosis provokes disturbances in the emotional state of women: 77.2% experience various psycho-emotional pathologies. 55.6% were diagnosed with unstable mood and irritability, 12.3% experienced anxiety, suffered from phobias and insomnia, and 9.3% of women complained of depression.

As Mekan Orazov notes, this is a mystery disease that can manifest itself as pain in the knee joints, and ultimately result in affective bipolar disorder.

Endometriosis in teenagers

Today, juvenile endometriosis is becoming increasingly common. According to WHO, in 50% of patients, the first symptoms of the disease appeared at the age of 24 years, in 21% before the age of 15, and in 17% at the age of 15–19 years. At the same time, as professor of department No. 1 of the medical faculty of the First Moscow State Medical University named after I.M. Sechenov, gynecologist-endocrinologist Irina Kuznetsova, says, the point is not at all that it has become better diagnosed: it’s just that you have it became more common: “Previously, it was believed that this was a disease of reproductive age. And now every fifth patient is diagnosed with endometriosis before the age of 15, and the disease appears even earlier.”

Risk factors for juvenile endometriosis include early onset of menstruation, short and heavy periods, underweight, and childhood sexual or physical abuse.

The first manifestation of endometriosis is most often pelvic pain, which can last for months and become chronic. At the same time, adolescents with endometriosis often experience urinary disorders and intestinal disorders. “Diagnosis of this disease in adolescents is difficult, and surgical treatment options are limited. We often make a diagnosis by chance, during an operation with suspected acute surgical pathology,” continues Kuznetsova.

There are also some problems with treating adolescents.

The main tactics for treating endometriosis today remains conservative treatment, because in this case the woman retains her reproductive function. But after surgical treatment, in many cases the patient will have to forget about further procreation.

“Modern endometriosis has become younger and more aggressive. And in young women, any ovarian surgery can reduce ovarian reserve or worsen the results of assisted reproductive technologies. After surgery for endometriosis, a decrease in ovarian reserve is observed,” says Vitaly Kuleshov, professor of the department of obstetrics and gynecology of the medical faculty of the Federal State Budgetary Educational Institution of Higher Education NSMU.

But still, in some cases it is no longer possible to do without surgery. For example, if the pain is not relieved by any pills or if some acute situation arises (for example, a cyst rupture). In addition, surgical treatment of endometriosis is recommended for postmenopausal women. Possible carcinogenic transformation also speaks in favor of surgery: the risk of developing cancer with endometriosis is 1.5%. However, the risk of ovarian cancer is increased to 6.2%, endometrial cancer – to 4.1%, breast cancer – to 1.8%. Surgeries are also offered to women with infertility or a high prevalence of the process. However, unfortunately, even after surgery, relapses of the disease are possible (after 5–7 years they occur in 50–55% of cases). Therefore, after surgery, patients are prescribed hormonal therapy. In addition, the operation does not treat the underlying cause of the disease, but only eliminates the pain.

The earlier the disease is detected, the greater the chance of avoiding surgery. By the way, the drugs that were prescribed in such cases before suppressed ovarian function and reduced the level of estrogen – female sex hormones. This caused symptoms similar to menopause: hot flashes, increased heart rate, increased risk of fractures. But today, the treatment of endometriosis has changed significantly.

As Professor Orazov says, today doctors can control pain, relapses of the disease, fertility, a woman’s ovarian reserve and her quality of life: “The main goal of therapy is to preserve the ovarian reserve, so surgical treatment is carried out only in special cases. For example, with an acute abdomen. In a patient of reproductive age, it is important to control pain, which is a hallmark of endometriosis. Therefore, the first line of therapy is non-steroidal anti-inflammatory drugs. If the pain persists, adolescents are prescribed complex oral contraceptives, even if they are not sexually active. The first line of treatment also includes therapy with hormonal agents of the progestogen class, which prevents the further development of endometriosis, blocks the proliferation of endometrial cells, eliminates pain, and relieves inflammation. If drug therapy does not help with severe pain, surgical intervention is considered. In adolescents, during such operations, the main task is to preserve the ovarian reserve. If we run after every patient with a scalpel, we will get tired of running.”

“The first line of treatment for pelvic pain in adolescents is non-steroidal anti-inflammatory drugs,” says Professor Kuznetsova. “If they don’t help, we move on to other drugs.” But teenagers have some limitations. For example, they cannot always be prescribed progestins – they can negatively affect future fertility and ovarian reserve. They can be prescribed some complex oral contraceptives. Severe pain that does not go away after three cycles of complex oral contraceptives requires surgical treatment. Vitamins B and D and chromium are used as supportive treatment.”

And yet doctors admit: there is no method of completely curing endometriosis today. Perhaps he will appear in the future. In the meantime, as Mekan Orazov says, endometriosis goes away in English, leaving only pelvic pain and other dysfunctions goodbye: “This disease is lifelong. She robs a woman of her best years. And it requires lifelong management of patients.”

HELP “MK”

Symptoms of endometriosis: severe pain during menstruation that interferes with a normal lifestyle (only in 5% of women the disease occurs without pain).

Menstrual irregularities (either prolonged, heavy menstruation, leading to anemia, weakness, fatigue, or irregular and scanty menstruation).

Chronic pelvic pain, including during sexual intercourse, urination, defecation.

Bloating, nausea.

Increased fatigue – Women with endometriosis are 153 times more likely to experience chronic fatigue compared to patients without the disease.