Dec 10, 2014 5 min read

Q.I think my daughter has endometriosis. She is only 13 and has a lot of pain with her periods. It’s hard for her to go to school or play sports (she plays soccer and basketball). During her period, she’s pretty miserable. I had endometriosis when I was a teen. It’s cleared up now, but I saw a number of doctors before they diagnosed it in my 20s and put me on the pill. I have three problems. Can you help me explain endometriosis to her? I mentioned she might have it, and she’s now afraid and confused. The second problem is I want to take her to the doctor, but I don’t know where to take her. Isn’t she too young for a gyne visit? The third problem is my husband. I told him going on the pill helped me – this is before we met. He says she’s too young for endometriosis and thinks putting our daughter on the pill will make her have sex. I think that’s ridiculous. She’s 13, and the last thing on her mind is sex. I hate seeing her in pain every month. I had you for sex ed, and so did my husband. What do you think?

Mom of 13-year-old

Mary Jo’s response: There are many reasons for painful menstruation. Endometriosis is certainly one cause. I hear your concern. Your personal experience makes it difficult to witness your daughter’s pain. Myths associated with menstruation often dismiss pain as “all in a woman’s head” or just “part of being a woman.” Untrue. Severe pain during periods is not normal.

Your husband is not alone in thinking endometriosis doesn’t occur in young women. Research indicates up to two-thirds of women experience endometriosis symptoms before they’re 20. Studies also show that diagnosing and treating endometriosis early can ease symptoms over time and lowers the chance of the symptoms getting worse.

Let’s look at your second problem first. I agree, she should see a health-care provider. I also think she’s a little young for a gynecologist (gyne) visit as a first choice. Pediatricians are trained to address issues like this one; early adolescence is still a pediatric area. If she doesn’t have a relationship with a pediatrician, I recommend scheduling a appointment. A gyne visit may be necessary, of course. Your pediatrician will help you make that decision.

Before the visit, prepare your daughter for an exam that includes touching her abdomen. Thirteen-year-olds can be modest and threatened by nudity. I don’t think an internal exam will happen first. Ask your daughter if she is comfortable with you attending the exam. Two sets of ears are better than one, and she may need your presence as a comfort, but her privacy is important. Give her a choice and respect that choice.

You should bring a history of her menstrual cycles since they began. Some doctors recommend women create a “pain map” worksheet to describe symptoms. Track your daughter’s symptoms: when in her cycle they occur, the type of pain (dull, crampy, sharp, aching), if/how the pain is affected by exercise, what over-the-counter treatments you’ve used, how the discomfort affects her life, the location (where the pain is felt), the duration of the pain (how long it lasts) and its intensity (ask her to describe the pain and label it on a scale from one to 10, with 10 being the highest pain).

Endometriosis deals with the endometrium (the lining of the uterus). Endometriosis occurs when tissue similar to the inside lining of the uterus is found outside of its normal location. Endometrial implants (cells) can be found on the ovaries, fallopian tubes and ligaments that support the uterus and tissue covering the bladder and rectum. Pelvic (abdominal) pain can occur during a period and also at other times during the menstrual cycle.

Other symptoms of endometriosis may include:

• Pain with urination

• Diarrhea or constipation

• Bloating or nausea

• Excessive bleeding

• Pain during intercourse

• Difficulty getting pregnant

I suggest the M.D. visit first simply because preparing your daughter for a diagnosis that may not be accurate isn’t necessary. Your pediatrician (or a gynecologist) will be able guide you if she truly is dealing with endometriosis.

Reassure your daughter. Endometriosis is not her fault. It is not a sexually transmitted infection. It is not cancer. She’s not imagining the pain.

Diagnosing endometriosis typically involves a laparoscopy (a surgical procedure where a small camera is inserted into the abdomen using a small incision). One treatment for endometriosis is hormonal treatment like birth control pills. Your husband is not alone; many adults confuse the need for hormonal treatment with encouraging sexual involvement. There are many reasons teens have sex. Teach your daughter. If she’s interested in sex, easing her pain through a medically prescribed hormonal treatment won’t give her “permission.” Talk honestly with her. Relationships, peer pressure, her own developing sexuality, ways to say no and how to communicate with a partner are all important topics for a parent/youth conversation at 13, regardless of her medical diagnosis. Open the door to healthy discussion now. Continue to connect with her as she reaches adulthood.

Your daughter is lucky you’re her mom. Please keep in touch.