QC: Evolution of Endometriosis From Teen to Young Adult

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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

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Episode Transcript

Speaker 1 (00:00):
How does endometriosis change as we move
from teenage years intoadulthood?
Why do so many patients gettold it's just IBS, anxiety or
even a lack of experience?
In this episode of EndoBatteryQuick Connect, dr Megan Wasson
breaks down the evolution ofendosymptoms, the most common
misdiagnoses and when it's timeto consider surgery versus

(00:21):
sticking with conservativetreatments.
Whether you're newly diagnosedor have been battling endo for
years, this conversation willgive you clarity, validation and
practical next steps.
Stay tuned.
This is one you don't want tomiss.

Speaker 2 (00:37):
Life moves fast and so should the answers to your
biggest questions.
Welcome to EndoBattery's QuickConnect, your direct line to
expert insights Short, powerfuland right to the point.
You send in the questions, Ibring in the experts and in just
five minutes you get theknowledge you need.
No long episodes, no extra timeneeded, and just remember

(00:58):
expert opinions shared here arefor general information and not
for personalized medical advice.
Always consult your providerfor your case-specific guidance.
Got a question?
Send it in and let's quicklyget you the answers.
I'm your host, alana, and it'stime to connect.
Today's guest, dr Megan Wasson,is the chair of the Department

(01:20):
of Medical and SurgicalGynecology at the Mayo Clinic in
Arizona and a professor ofobstetricsurgical Gynecology at
the Mayo Clinic in Arizona and aprofessor of obstetrics and
gynecology at the Mayo Clinic ofMedicine and Science.
She's a leader in minimallyinvasive gynecologic surgery and
a respected educator, namedOutstanding Emerging Educator of
2020.
And she's an internationallyrecognized speaker, with over
200 invited lectures and morethan 70 peer-reviewed

(01:45):
publications.
Her clinical focus includesendometriosis, chronic pelvic
pain and advanced surgicaltechniques.
Whether it's in the operatingroom, at the podium or shaping
global surgical standards, drMegan Wasson is helping redefine
what care can look like forpatients around the world.
Let's get into this.
How does endo tend to evolvefrom adolescence into adulthood?

Speaker 3 (02:08):
Yeah, we know that endometriosis is a progressive
condition, so it's not uncommonfor not only the disease to grow
.
If we're doing like imaging,watching things on ultrasound
MRI, it's not uncommon for thereto be that progression and
disease burden.
But it's also not uncommon tosee progression and symptoms.
That initially, yeah, I hadpainful cycles.

(02:30):
I was starting on birth controlpills as a 13 year old which,
again, I don't necessarilydisagree with.
I think that's fine as a firststep and, yep, it worked.
I put a bandaid on it.
But now I'm 18, 19, 20, and nowI'm starting to have pain
outside of my cycle or the painis no longer controlled with the
birth control pills.
That we're starting to see moreand more symptoms.

(02:51):
That's a very classicpresentation of endometriosis.

Speaker 2 (02:56):
Yeah.
What are the commonmisdiagnoses during this time?

Speaker 3 (03:01):
Yeah, so irritable bowel syndrome is a very, very
common one.
That, yes, you can have somediarrhea, constipation and
that's just anxiety as well, isa very common misdiagnosis.
Lack of sexual experience issomething that I very commonly
hear as well, that people arehaving difficulty with

(03:22):
intercourse just because they'renew in their sexual journey and
so it'll just take a little bitof time.
Primary dysmenorrhea is anothervery common word thrown out,
and diagnosis thrown out, thatit's because of the
prostaglandins that the uterusreleases and that's where the
pain is coming from.
Also labral tears, soorthopedic injuries can be the

(03:44):
source.
Truly, everyone wants to thinkabout things outside of GYN.

Speaker 2 (03:50):
When we're starting to think about progressive
symptoms as well, when shouldsomeone push for surgical
consultation versus going on theconservative management route?

Speaker 3 (04:00):
Yeah, yeah, that's a really great question and it's
not a one size fits all.
I always step back and remindmyself, as well as the
individuals that I'm caring for.
This is a quality of life issue.
So just because a treatmentoption is a good option for one
person doesn't mean it's bestfor another person and it really
needs to be individualized toyou, focused on your priorities,

(04:22):
your goals, your expectations.
Your priorities, your goals,your expectations.
So, in terms of when someoneshould consider surgery, lots of
different reasons.
Number one, if it's somethingthat's always been in the back
of your mind and constantly beenthis well, do I have it, do I
not have it?
And it keeps you up at nightand is causing a lot of anxiety,
a lot of stress For someindividuals.
Just having that definitive yesor no is this or is this not

(04:44):
endometriosis gives so muchpeace of mind and so much peace
in general that it's incrediblyhelpful.
So that's where I am neveropposed to just giving someone
that definitive answer.
But when we talk about theother quality of life issues, so
those symptoms, if someone ishaving symptoms that are not
being controlled with thoseband-aids, the birth control

(05:05):
pills, iuds, progesterone-onlypills then that's where there
should be a very thoughtfulconversation about is it time to
do something different, andthat may include surgery versus
pelvic floor, physical therapy,acupuncture there's a lot of
adjuncts that we can use to helpsupport the body as it
processes and copes withendometriosis.

(05:26):
To help support the body as itprocesses and copes with
endometriosis.
Additionally, if someone iswanting to pursue pregnancy and
cannot be on those Band-Aidmedications because, let's be
honest, being on birth controlpills when you're trying to get
pregnant, that is not conducive.
So if you can't be on yourBand-Aid and being off the
Band-Aid is not conducive either, can't be on your band-aid and

(05:48):
being off the band-aid is notconducive either.
Yeah, Doing a surgery mayabsolutely be justified at that
precise moment in time, with thesecondary benefit of not only
can we surgically help todecrease those symptoms, but we
can also help optimize, whetherthat's for natural pregnancy,
which there is good evidence toshow that removing endometriosis
can help optimize for naturalfertility, being able to get

(06:08):
pregnant without anyintervention, as well as helping
to optimize for artificialreproductive technology.
So, individuals who do needthings like intrauterine
insemination, in vitrofertilization, excising
endometriosis, getting rid ofthat inflammation, can help to
optimize for that as well.

Speaker 2 (06:26):
That's a wrap for this Quick Connect.
I hope today's insights helpedyou move forward with more
clarity and confidence.
Do you have more questions?
Keep them coming.
Send them in and I'll bring youthe expert answers.
You can send them in by usingthe link in the top of the
description of this podcastepisode or by emailing contact
at endobatterycom or visitingthe endobatterycom contact page.

(06:50):
Until next time, keep feelingempowered through knowledge.