An Exercise in Persistence
Delayed Endometriosis Diagnosis Affects Student Athletes
Adolescence is a time of self-discovery and pursuing dreams, but for some young girls, it also means silently battling a debilitating condition known as endometriosis. This chronic disorder, affecting one in ten females worldwide, often goes undiagnosed or misdiagnosed, leading to severe pelvic pain, heavy periods, and, at times, fertility issues. Amid this struggle, student athletes face unique challenges as they strive to excel in sports while managing their academic responsibilities- but many student athletes are also forced to face endometriosis head-on. There is a need for compassionate healthcare and support for student athletes dealing with this condition.
Hannah's Story
Hannah, a seventeen-year-old student athlete from Katy, Texas, embarked on her endometriosis journey with chronic lower back pain at the age of thirteen. This excruciating pain led to frequent school absences, initially attributed to a sports injury due to her active lifestyle. Her family consulted various doctors, including an orthopedist who prescribed a back brace, believing the issue to be a spine stress fracture. However, the pain persisted, and some physicians dismissed her condition, with one even suggesting it was psychological.
It was only when Hannah and her family met Dr. Angie Curtis, a pediatric sports medicine physician, that the pieces of the puzzle started coming together. Dr. Curtis took a holistic approach, going beyond sports medicine, and began asking questions about Hannah's menstrual cycle. Through collaboration with a gynecologist, they identified a connection between her back pain and endometriosis, a connection often overlooked by many. Lower back pain is a common but underrecognized symptom of this condition.
This collaboration eventually led to Hannah's endometriosis diagnosis. Hormone therapy was initiated, and gradually, Hannah's pain subsided, allowing her to return to sports. Her story underscores the critical role compassionate healthcare providers play in recognizing endometriosis in student athletes, ensuring they receive the proper treatment and can continue pursuing their dreams.
Stacy's Struggle
Stacy*, a twenty-year-old NCAA Division II volleyball athlete, faced a series of medical challenges linked to endometriosis. Her ordeal began with lower abdominal and pelvic pain after a volleyball practice, despite having no prior history of abdominal issues. As her condition worsened, she found herself unable to urinate despite the urge, leading to immediate removal from practice for evaluation.
Stacy's pain escalated, and she was rushed to the hospital's emergency room, where initial tests yielded negative results. A catheter was inserted to relieve urinary retention, and her endometriosis diagnosis followed. Multiple examinations, including a CT scan, vaginal ultrasound, and laparoscopy, confirmed the presence of endometriosis and multiple adhesions on various organs.
dress her condition, Stacy opted for Laparoscopic Uterine Nerve Ablation (LUNA). Although her post-surgery recovery initially went well, she experienced recurring abdominal pain, nausea, and fatigue upon resuming her training program. These symptoms, accompanied by a low-grade fever, led to further consultations with her physician. Ultimately, despite undergoing surgery, Stacy faced the heartbreaking decision to withdraw from volleyball participation and sacrifice her athletic scholarship due to the recurrent challenges posed by endometriosis.
The Complex Reality for Student Athletes
Both Hannah's and Stacy's stories shed light on the silent struggle faced by many student athletes with endometriosis. Often, their pain is wrongly attributed to sports injuries, leading to misdiagnosis or mistreatment. With awareness and empathetic healthcare providers, these athletes can find relief and continue pursuing their dreams, but many others face significant challenges.
Student Athletes' Perspectives
Research on student athletes with endometriosis has highlighted their concerns regarding reproductive health and athletic activities. Athletes have shared various strategies for managing menstrual pain during training and competitions, including pain medication and mindful breathing techniques. They've also discussed the importance of a strong support system, as well as their struggles with anxiety and depression.
Many athletes have emphasized the need for increased awareness of endometriosis in sports and have advocated for accommodations such as flexible training schedules during menstruation. These insights highlight the resilience and determination of student athletes dealing with endometriosis, as well as the critical importance of understanding and addressing their unique needs.
Medical Insights for Adolescents with Endometriosis
Adolescents with endometriosis often experience primary dysmenorrhea, which can start within 6-12 months of menarche. When evaluating secondary dysmenorrhea, pelvic imaging with ultrasonography should be considered, regardless of pelvic examination findings. This is particularly important, as about two-thirds of adolescent girls with chronic pelvic pain or unresponsive dysmenorrhea will be diagnosed with endometriosis.
For adolescents with endometriosis, a combination of conservative surgical therapy for diagnosis and treatment, along with ongoing suppressive medical therapies to prevent endometrial proliferation, is recommended. Adolescents can be treated with hormonal therapy, including continuous combined hormonal contraceptives, progestin-only agents, or levonorgestrel-releasing intrauterine systems (LNG-IUS). Patients may need to try various hormonal suppression methods to find the most effective one, with adequate counseling on potential risks and benefits.
Nonsteroidal anti-inflammatory drugs (NSAIDs) should be the primary choice for pain relief in adolescents with endometriosis, while long-term use of narcotics for managing endometriosis pain is discouraged outside of specialized pain management teams.
A Message for All Student Athletes
Endometriosis is a condition that affects millions of women and young girls worldwide. It's crucial to understand that debilitating pain during menstruation or sports is not normal. To all student athletes facing similar challenges, remember Hannah and Stacy's stories - don't let anyone dismiss your pain. Seek medical help, advocate for your health, and remember that your dreams are worth fighting for. With the right support and awareness, you can triumph over endometriosis and continue to shine both in the classroom and on the field. Your health should never be compromised, and you are not alone in this journey.
