In some teenage girls, very painful menstrual periods that interfere with daily life may signal an increased risk of developing the most extensive form of endometriosis, a preliminary study suggests.
In a study of 229 women undergoing surgery for endometriosis, French researchers found that those deep infiltrating endometriosis (DIE) were more likely to have had particularly painful periods as teenagers.
The 98 women with DIE were more than three times as likely as women with non-DIE endometriosis to have used birth control pills to treat severe menstrual pain before the age of 18. And they were also more likely to say they'd missed school days because of menstrual symptoms.
The findings, published in Fertility and Sterility, suggest that such problems in adolescence can sometimes predict a later diagnosis of DIE.
Different kinds of endometriosis
The authors point out that there are three forms of endometriosis: superficial endometriosis, ovarian endometriomas and DIE. Women with DIE usually have adhesions in multiple areas of the pelvis, including the vagina, bladder, bowel and the ligaments attaching the uterus to the pelvis.
Endometriosis can be tricky to diagnose, and many girls and women go years before a diagnosis. It can be mistaken for ovarian cysts, pelvic inflammatory disease or, depending on the symptoms, irritable bowel syndrome. The only way to definitively diagnose it is through minimally invasive laparoscopic surgery to take a tissue sample.
Compared with the other forms of endometriosis, DIE appears to have a longer delay to diagnosis.
Study search for early symptoms
So for the new study, Dr Charles Chapron and colleagues at Universite Paris Descartes tried to find out whether women undergoing surgery for endometriosis had any early symptom history that was associated with a greater likelihood of having DIE.
Overall, 58% of women with DIE had ever been prescribed birth control pills to treat severe menstrual pain, versus 26% of women with non-DIE forms. Similarly, 21% of women with DIE had their first prescription before the age of 18, compared with 6% of those in the non-DIE group.
When it came to missed school days, 38% of DIE patients said they'd had absences due to menstrual symptoms, versus 25% of women in the non-DIE group.
A family history of endometriosis was more common in women with DIE (13%) than in women with non-DIE cases (5%).
The study has a number of limitations, including the fact that it surveyed women at one time point (at an average age of 32) and asked them to recall symptoms from adolescence. A study that followed young women over time to see whether symptoms predicted a later diagnosis of DIE would be more informative.
These findings now set the groundwork for such a long-term study, Chapron told Reuters Health in an email.
But the "crux of the issue," he noted, is whether diagnosing endometriosis earlier will eventually lead to fewer cases of DIE and less need for surgery.
"Today, there is no effective way to prevent the progression of endometriosis to its most severe stage, DIE," Chapron said.
And the current results, he noted, suggest that treating severe menstrual pain with birth control pills does not prevent progression to DIE, as a history of such treatment was linked to the condition. Chapron also pointed out, however, that this does not mean that birth control pills contributed to the development of DIE either.
Still, even though it is not clear whether progression to DIE can be prevented, an earlier diagnosis of endometriosis would at least allow girls and women to know the cause of their symptoms.
According to Chapron and his colleagues, girls and women with severe menstrual pain that does not respond to pain relievers like ibuprofen should be evaluated for endometriosis.
Besides painkillers and birth control pills, non-surgical treatments for endometriosis include several types of hormonal medications that inhibit the growth of the endometrial tissue. - (Amy Norton/Reuters Health, November 2010)