Children's Hospital Colorado

Endometriosis in Girls

What is endometriosis?

Endometriosis is a condition that occurs when tissue from the inner lining of the uterus (called the endometrium) spreads outside of the uterus. This tissue continues to act as it would inside the uterus during the menstrual cycle — thickening, breaking down and sometimes bleeding. The tissue causes inflammation and irritation resulting in pain, especially during a woman's period.

Endometriosis can affect women of any reproductive age, from their first period to menopause. Most commonly, endometrial tissue spreads to the ovaries, fallopian tubes, outer lining of the uterus and surrounding pelvic tissues. Endometriosis can cause inflammation and scarring, and without treatment, it will usually persist and worsen over the reproductive years.

At Children's Hospital Colorado, our pediatric and adolescent gynecologists are experienced in treating endometriosis in girls, teens and young women. We provide expert guidance for all steps of treatment, from diagnosis to treatment and follow-up care to help young women live without pelvic pain.


What causes endometriosis?

The causes of endometriosis are unknown. However, we believe that estrogen, a naturally occurring hormone, causes it to spread and worsens endometriosis pain. Endometriosis typically begins developing in the months and years after young women start having menstrual periods. When women with endometriosis reach menopause and their estrogen levels drop, their symptoms usually subside.

Who gets endometriosis?

Endometriosis can occur in any girl or woman who has started having menstrual periods. It affects approximately 10% of women. Most young women are diagnosed in their late teens and 20s. Women who have a first-degree relative (mother or sister) with endometriosis are seven times more likely to develop endometriosis than girls who do not have a close relative with the condition.

Is endometriosis associated with infertility?

Endometriosis does not cause infertility, but women with the condition typically have more difficulty getting pregnant. Between 20% and 50% of women experiencing infertility also have endometriosis. Inflammation caused by endometriosis can cause a number of changes to a woman's reproductive system that increase infertility.

At Children's Colorado, our care team works to diagnose and treat endometriosis early to reduce the odds of infertility.

What are the signs and symptoms of endometriosis in young women?

Many girls and women with endometriosis have no symptoms, but those who do commonly experience:

  • Pelvic pain that becomes worse during menstrual periods
  • Pelvic pain not relieved with over-the-counter pain medications
  • Pelvic pain with urination or bowel movements
  • Abnormal menstrual bleeding
  • Pain during or after sex
  • Infertility

How is endometriosis diagnosed?

A gynecologist who is experienced in diagnosing and treating endometriosis performs the initial diagnosis. The doctor will ask about menstrual periods, cramping, pelvic pain, medical history and therapies patients have tried to relieve the pain.

Doctors might suspect endometriosis when pain is severe and has not been relieved by over-the-counter pain medications and/or birth control pills. Office evaluation sometimes includes a pelvic ultrasound, but often endometriosis does not cause ovarian cysts or other changes that are visible on ultrasound in teens and younger women. Our care team may conduct an ultrasound if pain is more severe than is typical with endometriosis or menstrual history suggests that an ovarian cyst is causing the pain.

Endometriosis is only diagnosed with absolute certainty with a surgical biopsy, which is done via a minimally invasive surgery called a diagnostic laparoscopy. Many young women with suspected endometriosis do not need a surgical diagnosis because their endometriosis symptoms are well controlled with medical treatment. We only perform a laparoscopy if medical treatment doesn't resolve endometriosis symptoms.

What to expect from an exam for endometriosis

At Children's Colorado, we approach each potential endometriosis diagnosis individually. We take into account your daughter's personal history, circumstances and goals to create the best care plan for her.

Your child's medical history is the most important part of an exam for endometriosis. Diagnosis also includes a basic abdominal exam. We rarely perform a traditional pelvic exam in our clinic because we can typically obtain the same information from the medical history and other less invasive techniques.

Endometriosis treatment in girls and teens

There is no cure for endometriosis, but treatment can help young women manage their symptoms and significantly reduce endometriosis pain. Endometriosis spreads over time and should be evaluated and treated as soon as possible to minimize long-term pain.

At Children's Colorado, we offer both surgical and nonsurgical approaches to treatment. Our care team will recommend the best treatment options for each patient.

Nonsurgical endometriosis treatment for young women

While we can't definitively diagnose endometriosis without surgery, suspected cases may be managed with nonsurgical treatment methods, particularly if symptoms are not severe. Nonsurgical treatments are usually the first step for girls, teens and young women who are not currently trying to become pregnant. The most common nonsurgical treatments are hormonal medications that cause endometrial lesions (endometrial tissue outside of the endometrium) to shrink and prevent the further spread of the condition. Hormonal medications include:

  • Oral progesterone pills
  • Birth control pill, patch, ring or injection
  • Intrauterine devices (IUDs) that contain progesterone
  • An implant that goes under the skin
  • An injection that blocks the production of estrogen

Many girls, teens and young women will try several of these medications or use them together to control their endometriosis symptoms. Although many of these treatments are labeled as "birth control," they are effective medical treatments for endometriosis and do not increase the likelihood of sexual activity. Because nonsurgical treatments reduce the spread of endometriosis, they play an important role in protecting the future fertility of young women with this condition.

Surgical endometriosis treatment for young women

For some girls and women, endometriosis surgery is the best option. When surgery for endometriosis is necessary, our experienced team will guide your family through the process.

Outpatient laparoscopic surgery for endometriosis can effectively diagnose and treat the condition. Both diagnosis and treatment can take place during the same operation. During surgery, a high-energy heat source, such as a laser, cuts or burns away endometrial lesions (endometrial tissue outside of the endometrium). Treatment is more difficult with advanced disease that involves large areas of the rectum or larger lesions.

More recently, laser ablation with a CO2 laser has allowed for more extensive treatment of endometriosis. This technique treats more visible lesions while decreasing risk of injury to surrounding organs. Our experienced gynecologists on the Children's Colorado team, have undergone specialized training and certification in endometriosis laser treatment.

Following surgery, our team will guide your daughter's use of hormonal medications to prevent the regrowth of endometriosis.

Why choose Children's Colorado for endometriosis treatment?

Our board-certified pediatric and adolescent gynecologists have specialized training and a wealth of experience in the reproductive health issues of girls and women of all ages.

We understand that endometriosis can be stressful and are sensitive to your needs. That's why we work to put families at ease by carefully explaining endometriosis, discussing the various treatment options and supporting your family with follow-up visits and consultation with our colleagues in other specialties, such as psychology, chronic pain, urology and gastroenterology, if needed.

In addition to a welcoming setting, we offer expertise in the full range of diagnostic and treatment options for endometriosis from routine exams and medication to surgery, if needed.

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