QC: Evolution of Endometriosis From Teen to Young Adult

Endometriosis evolves from teenage years into adulthood, often progressing from manageable period pain to symptoms outside the menstrual cycle that no longer respond to hormonal treatments. Dr. Megan Wasson, Chair of Medical and Surgical Gynecology at Mayo Clinic Arizona, breaks down this journey and provides clarity on when to consider moving beyond conservative management.

• Endometriosis commonly progresses in both disease burden and symptom severity over time
• Common misdiagnoses include IBS, anxiety, "lack of sexual experience," primary dysmenorrhea, and orthopedic issues
• Decision for surgery should be individualized based on quality of life considerations
• Surgery may be appropriate when diagnostic uncertainty causes anxiety
• Surgical treatment can be beneficial when symptoms aren't controlled by hormonal treatments
• Removing endometriosis can optimize fertility for both natural conception and assisted reproductive technologies
• Complementary approaches like pelvic floor physical therapy and acupuncture can support conventional treatments

Send your questions to contact@endobattery.com or visit endobattery.com/contact, and we'll bring you expert answers in our next Quick Connect episode.

Chapters

• 0:00 Endo's Evolution Through Life Stages
• 1:14 Common Misdiagnoses Explained
• 3:00 When to Consider Surgery
• 5:49 Fertility and Endometriosis
• 6:26 Episode Wrap-Up

Transcript

Speaker 1: 0:00

How does endometriosis change as we move from teenage years into adulthood? Why do so many patients get told it's just IBS, anxiety or even a lack of experience? In this episode of EndoBattery Quick Connect, dr Megan Wasson breaks down the evolution of endosymptoms, the most common misdiagnoses and when it's time to consider surgery versus sticking with conservative treatments. Whether you're newly diagnosed or have been battling endo for years, this conversation will give you clarity, validation and practical next steps. Stay tuned. This is one you don't want to miss.

Speaker 2: 0:37

Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect.

Speaker 2: 1:17

Today's guest, dr Megan Wasson, is the chair of the Department of Medical and Surgical Gynecology at the Mayo Clinic in Arizona and a professor of obstetricsurgical Gynecology at the Mayo Clinic in Arizona and a professor of obstetrics and gynecology at the Mayo Clinic of Medicine and Science. She's a leader in minimally invasive gynecologic surgery and a respected educator, named Outstanding Emerging Educator of 2020. And she's an internationally recognized speaker, with over 200 invited lectures and more than 70 peer-reviewed publications. Her clinical focus includes endometriosis, chronic pelvic pain and advanced surgical techniques. Whether it's in the operating room, at the podium or shaping global surgical standards, dr Megan Wasson is helping redefine what care can look like for patients around the world. Let's get into this. How does endo tend to evolve from adolescence into adulthood?

Speaker 3: 2:08

Yeah, we know that endometriosis is a progressive condition, so it's not uncommon for not only the disease to grow. If we're doing like imaging, watching things on ultrasound MRI, it's not uncommon for there to be that progression and disease burden. But it's also not uncommon to see progression and symptoms. That initially, yeah, I had painful cycles. I was starting on birth control pills as a 13 year old which, again, I don't necessarily disagree with. I think that's fine as a first step and, yep, it worked. I put a bandaid on it. But now I'm 18, 19, 20, and now I'm starting to have pain outside of my cycle or the pain is no longer controlled with the birth control pills. That we're starting to see more and more symptoms. That's a very classic presentation of endometriosis.

Speaker 2: 2:56

Yeah. What are the common misdiagnoses during this time?

Speaker 3: 3:01

Yeah, so irritable bowel syndrome is a very, very common one. That, yes, you can have some diarrhea, constipation and that's just anxiety as well, is a very common misdiagnosis. Lack of sexual experience is something that I very commonly hear as well, that people are having difficulty with intercourse just because they're new in their sexual journey and so it'll just take a little bit of time. Primary dysmenorrhea is another very common word thrown out, and diagnosis thrown out, that it's because of the prostaglandins that the uterus releases and that's where the pain is coming from. Also labral tears, so orthopedic injuries can be the source. Truly, everyone wants to think about things outside of GYN.

Speaker 2: 3:50

When we're starting to think about progressive symptoms as well, when should someone push for surgical consultation versus going on the conservative management route?

Speaker 3: 4:00

Yeah, yeah, that's a really great question and it's not a one size fits all. I always step back and remind myself, as well as the individuals that I'm caring for. This is a quality of life issue. So just because a treatment option is a good option for one person doesn't mean it's best for another person and it really needs to be individualized to you, focused on your priorities, your goals, your expectations. Your priorities, your goals, your expectations.

Speaker 3: 4:25

So, in terms of when someone should consider surgery, lots of different reasons. Number one, if it's something that's always been in the back of your mind and constantly been this well, do I have it, do I not have it? And it keeps you up at night and is causing a lot of anxiety, a lot of stress For some individuals. Just having that definitive yes or no is this or is this not endometriosis gives so much peace of mind and so much peace in general that it's incredibly helpful. So that's where I am never opposed to just giving someone that definitive answer. But when we talk about the other quality of life issues, so those symptoms, if someone is having symptoms that are not being controlled with those band-aids, the birth control pills, iuds, progesterone-only pills then that's where there should be a very thoughtful conversation about is it time to do something different, and that may include surgery versus pelvic floor, physical therapy, acupuncture there's a lot of adjuncts that we can use to help support the body as it processes and copes with endometriosis. To help support the body as it processes and copes with endometriosis.

Speaker 3: 5:30

Additionally, if someone is wanting to pursue pregnancy and cannot be on those Band-Aid medications because, let's be honest, being on birth control pills when you're trying to get pregnant, that is not conducive. So if you can't be on your Band-Aid and being off the Band-Aid is not conducive either, can't be on your band-aid and being off the band-aid is not conducive either. Yeah, Doing a surgery may absolutely be justified at that precise moment in time, with the secondary benefit of not only can we surgically help to decrease those symptoms, but we can also help optimize, whether that's for natural pregnancy, which there is good evidence to show that removing endometriosis can help optimize for natural fertility, being able to get pregnant without any intervention, as well as helping to optimize for artificial reproductive technology. So, individuals who do need things like intrauterine insemination, in vitro fertilization, excising endometriosis, getting rid of that inflammation, can help to optimize for that as well.

Speaker 2: 6:26

That's a wrap for this Quick Connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming. Send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.