Endometriosis in adolescents: the history 4

March 2013 declared the International Association of endometriosis "Month to raise awareness about endometriosis." So that more people know about this disease, MEDIKFORUM contributes by publishing a series of post-history of our expert gynecologist Oksana Bogdashevskoy about real cases of endometriosis.

Masha 18 years. At the reception it brought my mother - excited, loud, restless. In Masha painful menstruation. Very painful.

It was hard to talk. My mother tried to present a complaint to evaluate and draw conclusions. Prolix and noisy, she sincerely believes that it can better describe the complaint daughter daughter. Masha - an adult over the age of confidentiality girl. Align mother out of the room it was only after 10 minutes.

From history
Menstruation from 13 years, established immediately.
Regular - every 28-30 days.
Moderate.

In order to assess the severity of pain, we are using your - visual pain scale from "0" to "10", where at "0" no pain, and "10" - this is the most unbearable pain imaginable. Masha assessed pain during menstruation in 9 points.

- Monthly once were so painful?
- No, at first just unpleasant ache. And six months later already well so sick. Mum to me that just does not come on! And Nospanum and baralgin.
- A Nise, Nurofen tried?
- Yes, we all have tried. I already ketanov not help.
- The sexual life of the age to live?
- I do not live.
- Quite quite? No-way?
- No (smiling).

In the days of menstruation Masha does not study, does not meet with friends or hanging "in contact". Three or four days each month lying in Masha "pose sic" and grunts. With meticulous survey it found that in those days, Masha has difficulty with urination and defecation. The severity of constipation is estimated at 10 points on the VAS.

From history
Inspection and productive Vaginoscopy information is brought to - all right.
Pelvic ultrasound - corresponds to the phase of the menstrual cycle. Everything works like clockwork.

Generally, primary dysmenorrhea (painful periods), "normal" for a symptom of adolescence. However, 10% of   dysmenorrhea in adolescents   is secondary, that is associated with other disorders. Endometriosis - not uncommon at this age. According to the World Endometriosis Association, 38% of women, the symptoms of the disease first appear before the age of 15 years.

The presence of secondary dysmenorrhea can be assumed in the following cases:
• in patients who do not respond to commonly used to treat primary dysmenorrhea first-line drugs (NSAIDs and CCO);
• if dysmenorrhea occurs shortly after the menarche (within the first 6 months), because, as a rule, primary dysmenorrhea develops later, from the time of ovulatory cycles (in the middle and late adolescence).

Symptoms of endometriosis in adolescents may differ. Only 9.4% of adolescents complain cyclic pain, but more than 90% of them note acyclic dysmenorrhea pain with or without.
In the case of suspected endometriosis is usually applied a stepwise approach in the selection of medication. First-line drugs are NSAIDs (Nise, Nurofen, ketoprofen, etc.) And the COC in a cyclic or continuous mode.
With the ineffectiveness of these methods is recommended to carry out a diagnostic laparoscopy.

Features laparoscopic diagnosis in adolescents

The question of "to operate - not to operate" very complicated. Clear guidelines for today do not. Laparoscopy may be imposed in order to confirm the diagnosis of endometriosis in adolescents with generalized severe pelvic pain, in case of failure of medical therapy. In young patients often detected atypical endometrial lesions in the form of bubbles and pockets of bright red, extremely rare heterotopia classic color "powder burns".

The recommendations of the Canadian Society of Obstetricians Gynecologists 2010 Endometriosis: Diagnosis and management (Journal of Obstetrics and Gynaecology Canada 2010; 32 (7): 1-28)
1. Endometriosis - the most common cause of secondary   dysmenorrhea in adolescents .
2.   adolescents with endometriosis   are more likely than adult women, there is an acyclic pain.
3. On physical examination of adolescents with endometriosis rarely detected are any deviations, as most of them have the disease at an early stage.
4. Endometriosis in adolescents is often characterized by atypical manifestations. During the laparoscopy revealed atypical endometrial lesions in the form of bubbles and pockets of bright red color.
5. All the available methods of treating endometriosis are acceptable for teenagers, but should take into account the age of the patient and side effect profiles of drugs.

From history
We have put Masha diagnosis of "secondary dysmenorrhea. Suspicion of external genital endometriosis. "
Her mother angrily rejected the proposal to take COCs. The idea of ​​a diagnostic laparoscopy she also did not like. Visan decided to choose as the lesser of two evils.

Against the background of the first package of the drug, bothered spotting and drowsiness. Mom Masha was in a panic. With great difficulty, persuaded to continue receiving, using blackmail and easy voicing average price diagnostic laparoscopy. "Miracle" was already on the second package - the pain is almost gone. Masha assessed their pain by 2 points. Another good news was the complete disappearance of the problems with constipation. She continues treatment for 6 months. It feels great, depression, which so frightened mother reading the instructions, did not come. Masha still does not live sexual life.

We are faced with the question - what do we do next? How long will it take the drug? The unequivocal answer I have. I hope that from day to day priskachet prince on a white horse, and I'm in good conscience translate Masha Kok. We wait-with.

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