Ask a CHOC Doc: Do I Have Endometriosis?

Question: My periods are heavier and more painful than my friends’ periods. I’ve seen a lot in the news recently about endometriosis. Is that what I have?  -Anonymous

Answer: 

Any time you have questions about your body, ask a trusted adult or your doctor. What you’re describing may be endometriosis, but it could be something else. It could also just mean that you have heavier periods and more cramping than your friends do (everyone’s body is different) and you don’t have a diagnosable medical condition.

If you decide you need to see your doctor, here’s more information about endometriosis, so you can be prepared for your appointment.

 What is endometriosis?

Endometriosis is a condition where the tissue that makes up the inner lining of the uterus is present outside of the uterus, or n other organs in other parts of your body. It most often occurs in the ovaries and pelvis.

What are the symptoms of endometriosis?

The symptoms from endometriosis can vary significantly from woman to woman. Some people who have endometriosis actually have no symptoms, and others suffer from debilitating and chronic pain in the lower abdomen and pelvis. It can also cause pain with periods or during sexual intercourse and may even lead to infertility.

Since this condition occurs when tissue from the inner lining of the uterus is present outside that area, symptoms can vary depending on where the tissue is. For example, with bladder endometriosis, someone can have urinary symptoms such as frequency, urgency and pain. With bowel endometriosis, you can have diarrhea, constipation and bowel cramping. If the endometriosis is in the abdominal wall, there could be a painful abdominal wall mass.

Women who suffer from endometriosis are usually diagnosed between ages 25 to 35. However, teens may suffer from endometriosis as well. It’s rarely diagnosed in premenstrual and postmenopausal women.

During a menstrual cycle, the bleeding occurs not only from inside the uterus, which is typical, but also from areas with uterine tissue outside the uterus. The blood irritates these areas in the abdomen, and the irritation causes inflammation, pain and scar tissue.

 How do I know if I have endometriosis? 

In order to definitively diagnose endometriosis, a doctor will perform a laparoscopy, where they’ll make a small incision in the abdominal wall and insert a small camera in order to view the organs in the abdomen. They will remove a small sample of tissue and review it under a microscope to confirm that it is uterine tissue that’s been growing outside the uterus.

During the procedure, endometriosis can be assigned a stage of severity, based on the location and how much uterine tissue is growing outside of the uterus.

This procedure can make a diagnosis and also treat the pain from endometriosis by removing the uterine tissues found outside the uterus as well as removing scar tissue that may be affecting the pelvic organs. Surgery can help lessen the impact on fertility.

If your doctor suspects you might be suffering from endometriosis, they may choose to first explore non-surgical examinations before considering a laparoscopy. Your doctor may order an ultrasound to evaluate your anatomy and look for ovarian endometrioma (large, fluid-filled cysts), in addition to reviewing your medical history and conducting a physical examination. An assumed diagnosis might be made without surgery, but response or lack of response to treatments cannot confirm or exclude the diagnosis.

What is the treatment for endometriosis?

The most commonly prescribed medication is a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen. It is important to take the right dose as prescribed by your medical provider for adequate treatment of inflammation and pain relief. The use of cyclic hormonal therapy can be used for pain management. This includes using oral hormonal pills, commonly called “birth control,” or injection Depo-Provera to suppress menstruation and changes in uterine tissue, thereby decreasing pain. Another treatment option is the use of gonadotropin releasing hormone (GnRH) agonists, which can help stop the bleeding by decreasing estrogen production. Some side effects of GnRH agonists include menopause-like symptoms like hot flashes, mood changes, vaginal dryness and bone thinning, among others.

Medication should be trialed for at least three months. If there is no improvement to medical therapy within this trial period, your doctor may refer you to a gynecologist, and a laparoscopy surgery should be considered.

If there is any concern regarding a chronic pelvic pain, painful periods or other symptoms that are affecting your life, make a doctor’s appointment to get it evaluated!

By Dr. Janice Koh, pediatric resident at CHOC Children’s and Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s

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Teens and Acne

By Dr. Stephanie Lee, pediatric resident at CHOC Children’s

Teens and acne is a common struggle. Acne is the most common skin disorder in the United States. Although it is more common in teenagers, it can affect people of all ages.

Acne is not purely a cosmetic problem. The skin is the largest organ and should be kept healthy. Acne can lead to dark spots and scars if left untreated. Psychological side effects can come alongside teens and acne, including low self-esteem, depression and anxiety.

What is acne?

Acne occurs when a pore (also known as a hair follicle) becomes clogged. We normally shed dead skin cells, but they get trapped by an oily substance known as sebum, produced by glands near the hair follicles. Bacteria can also get trapped and cause inflammation.

Hormones increase sebum production, which is why teenagers are commonly affected by acne. Teens going through  puberty may have acne due to hormonal changes they’re going through. Girls may develop acne worsened by their periods.

There are different types of acne:

Non-inflammatory:

  • Whiteheads are closed pores with dead skin cells and sebum.
  • Blackheads are open clogged pores that darken due to a chemical reaction, rather than the common misconception that it’s dirt.

Inflammatory:

  • Papules are clogged pores infected by bacteria, leading to red raised bumps.
  • Pustules are pus-filled bumps.
  • Nodules are larger, hard bumps.
  • Cysts are clogged pores that break under the skin causing bigger areas of inflammation. These can be quite painful.

Acne is often located on the face, neck, chest, upper back and upper arms because these are where the sebaceous glands are more abundant.

Acne may also be seen in other health conditions that require further work-up with labs or imaging, such as polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia (CAH), or tumors. It can also be a side effect of certain medications. Other skin rashes may be confused with acne. If you aren’t sure whether your acne is due to hormones or another health condition, ask your pediatrician.

Teens and acne: treatments that work

Acne is categorized by severity, and treatment is prescribed based on this grading scale. There are many options for medications, and your pediatrician can help you find the one that is right for you. Some are available over-the-counter and do not need a prescription, which are typically helpful for mild acne. Common topical medications include benzoyl peroxide, adapalene, and antibiotics (clindamycin, erythromycin). Usually, you’ll try one of these first for mild to moderate acne. Benzoyl peroxide and adapalene are available over the counter without a prescription. Oral medications used to treat moderate to severe acne are usually antibiotics such as doxycycline, minocycline or tetracycline. For females, hormonal therapy such as oral contraceptives or spironolactone can be very helpful for treating acne. If you have more severe acne that does not respond to initial treatment, your doctor may consider prescribing isoretinoin (brand name Accutane).

Some of the medications can have anti-inflammatory, pore-clearing, and/or anti-microbial properties. Side effects for topical medications may include dry, irritated skin. Side effects for oral antibiotics may include upset stomach and/or sensitive skin, especially in the sun. These side effects can be minimized by using a facial moisturizer with SPF30 or more to keep your skin hydrated, prevent sun damage, and promote healing. Ask your doctor or pharmacist about possible side effects for specific medications. It may take two to three months to see improvement in acne with medications.

Teens and acne: dos and don’ts

There are many common misconceptions surrounding acne.

  • Frequent washing or scrubbing does not prevent acne; it can make it worse.
  • Popping pimples will not help get rid of them faster, but can push infections deeper beneath the surface of the skin and boost your risk of scarring.
  • There is limited evidence that acne gets worse if you eat greasy foods.
  • Stress may worsen acne but does not necessarily cause it.
  • Non-comedogenic (sometimes called acne formulation) products are better for acne-prone skin, which are often water-based.

It is best to talk with your doctor about your acne to get recommendations and treatment tailored to your needs.

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Meet our Teen Advisory Council

Say hello to our inaugural class of teen advisers.

The CHOC Children’s Teen Advisory Council is made up of outstanding teens who are active in their community, committed to academic success, and support CHOC’s mission to nurture, advance and protect the health and well-being of children.

Being a teenager isn’t easy. There’s peer pressure, academic pressure, hormones, and college applications to think about. Sometimes it’s helpful to get advice from a parent or trusted mentor, but sometimes as a teenager you just want to hear straight from other teens, especially about topics that may be hard to talk about.

You’ll see these faces on our blog, and hear them on our podcast, discussing how they and their friends deal with common issues teens face, from bullying to healthy eating to stress management, and everything in between. From time to time they may be joined by a CHOC Children’s clinician or other staff member.

Today, they’re giving us a sneak peek inside their summer plans.

choc-childrens-teen-adviser-alyssa

Alyssa Mercado, 14

This summer I am keeping busy babysitting for family and friends. I will be staying active by going to the gym, and training for the upcoming volleyball season. I am also maintaining my social life by meeting up with friends and hanging out on my free time.

choc-childrens-teen-adviser-layla

Layla Valenzuela, 12

This summer, I will be playing volleyball, participating in a fun theater camp, hanging out with friends and traveling to Alaska with my family. Playing volleyball during the summer will prepare me for the next club season and help keep me in shape. Performing arts is near and dear to my heart, as is hanging out with my friends and traveling with my family. It’s going to be a busy, but very fun and engaging summer!

choc-childrens-teen-advisor-heather

Heather Bisset, 14

I plan to keep busy this summer by playing tournaments with my club volleyball team, going to the beach and spending time with my friends, and studying for my upcoming AP European History class. I also hope to find a volunteer position at an animal shelter.

choc-childrens-teen-adviser-carina

Carina Alvaro, 14

This summer, I will be taking geometry to advance in math my sophomore year. I will also be participating in several softball recruiting tournaments in hopes of getting committed to a university on a softball scholarship. For fun, I will be hanging out with my friends at the beach and going to concerts.

choc-childrens-teen-adviser-cameron

Cameron Macedonio, 15

Since I have no mandatory commitments over summer like summer school, I am keeping busy by socializing and having fun. We like going to the movies, going out to eat, and going to amusement parks.

choc-childrens-teen-adviser-sanam

Sanam Sediqi, 16

This summer I am keeping up quite a busy schedule. I am currently taking summer college courses including American Sign Language. On the weekends, I work as a body artist for face paint at Disneyland.

choc-childrens-teen-advisor-zoe

Zoe Borchard, 14

This summer, I’m working hard to get the most out of my break. I’m enjoying my camp counseling position. When I’m not a counselor, I’m busy working on my online health  course for high school next year. I’m also traveling to Montana to visit family. Whatever free time I can get is spent reading, sketching or adventuring with friends.

Submit a question for our teen advisers

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HIV Symptoms and HIV Prevention

By Dr. Sora Song, pediatric resident at CHOC Children’s and Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s

HIV (Human Immunodeficiency Virus) is a virus that can spread through certain body fluids eventually attacking the body’s immune system and because of its potential severity, everyone who is sexually active should be aware of HIV symptoms and how to prevent HIV. HIV is a life-long illness, but people living with HIV have many different treatment options. Anyone who is HIV-negative and at risk of contracting the virus should know what they can do to decrease their chances of becoming infected PrEP and PEP, in addition to practicing safe sex, are options available for preventing HIV infection.

HIV symptoms in men and HIV symptoms in women

How long it takes for HIV/AIDS symptoms to appear can vary from person to person. Some people could look and feel healthy for years while they are infected. It is possible to infect others with HIV even if you have no symptoms. This means that getting tested regularly is important, even if you feel fine.

When a person’s immune system is overwhelmed by AIDS, they might notice:

  • Extreme weakness or fatigue
  • Rapid weight loss
  • Frequent fevers that last for weeks with no explanation
  • Heavy sweating at night
  • Swollen lymph glands
  • Minor infections that cause skin rashes and mouth, genital and anal sores
  • White spots in the mouth or throat
  • Chronic diarrhea
  • A cough that won’t go away
  • Trouble remembering things
  • Severe vaginal yeast infections that don’t respond to usual treatment
HIV prevention: PrEP

PrEP stands for pre-exposure prophylaxis. PrEP can stop HIV from infecting your body and spreading throughout your body. It is not a vaccine. PrEP is a pill that is actually a combination of two HIV medicines (tenofovir and emtricitabine) under the trade name Truvada®. This medicine has been approved for daily use. PrEP can cause side effects like nausea in some people but these generally improve over time. These side effects are not serious or life-threatening.

PrEP is taken before HIV exposure. It is taken every day. This is for people who don’t have HIV and are at very high risk for infection. It is recommended for those who:

  • have a sex partner who is HIV positive
  • have sex with a partner whose HIV status is unknown
  • are not in a mutually monogamous relationship with a partner who tested HIV-negative
  • have injected drugs or have shared needles in the past six months

For those at very high risk for HIV infection, PrEP can greatly lower your risk of infection if taken daily.

When used as directed, daily PrEP pills can reduce the risk of getting HIV from sex by more than 90 percent and from injection drug use by more than 70 percent. PrEP can be very effective if used as directed but is much less effective if not taken consistently. PrEP can only be prescribed by a health care provider. Your risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other methods of prevention. PrEP should be used daily and for as long as there is risk for HIV infection.

HIV prevention: PEP

PEP stands for post-exposure prophylaxis. It is a method of HIV prevention after possible exposure. It should be started within 72 hours (three days) after possible exposure to HIV. PEP has little or no effect in preventing HIV infection if it is started later than 72 hours after HIV exposure.

Someone using PEP will take a combination of medicines, usually all in one pill, that fights HIV infection. This pill can cause some side effects like nausea, in some people. These side effects are not serious or life threatening. PEP is only used for 28 days after possible HIV exposure. It is not a substitute for other HIV prevention methods, such as pre-exposure prophylaxis (PrEP). Someone can switch to PrEP right away after completing PEP for continued HIV prevention.

PEP is for people who are HIV-negative or don’t know their status and, in the last 72 hours, may have been exposed to HIV:

  • during sex
  • at work through a needlestick or other injury
  • by sharing needles
  • during a sexual assault

PEP can help prevent HIV infection when taken correctly, but it is not 100 percent effective. If you may have been exposed to HIV in the last three days, or if you aren’t sure if you have been exposed to HIV or not, talk to your healthcare provider immediately. Start PEP as soon as possible to give it the best chance of working. Individuals should continue to use condoms with sex partners and practice safe drug injection practices (for example, using your own sterile needles) while taking PEP. These different methods can reduce the chances of transmitting HIV to others if you do become infected while you’re on PEP.

Testing while Preventing HIV

Anyone who uses PrEP or PEP needs to have close follow-up with their medical provider to get testing for HIV and other sexually transmitted infections. PrEP users should have repeat testing done on a routine basis because if someone becomes HIV positive, they need additional blood tests as well as different medications for HIV treatment. PEP users need to see their providers more often to ensure the medication is working.

Talk to your health care provider about whether PrEP or PEP is right for you.

Learn more about adolescent medicine at CHOC.

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Rising Rates of Children’s Hospital Visits for Suicide Thoughts, Attempts

The percentage of patients seen at U.S. children’s hospitals each year for suicidal thoughts or attempts has increased steadily, according to a recent study published in Pediatrics, the official journal of the American Academy of Pediatrics.

Suicide is the second leading cause of death in children and young adults ages 10-24.

Rising rates for suicide thoughts, attempts infographic

Learn the warning signs of suicide in children and adolescents

Mental Health Inpatient Center

Our Mental Health Inpatient Center, which opened in April 2018, is the only center in Orange County that can accommodate children younger than 12. The 18-bed Center is designed for patients ages 3 to 17.

ASPIRE® Intensive Outpatient Program at CHOC Children’s

This intervention (four afternoons/evenings per week for eight weeks) is intended to prevent psychiatric hospitalization and re-admission in high school teens ages 13-18. CHOC opened the IOP in early 2018.

Mental health screenings in primary care settings and the Julia and George Argyros Emergency Department at CHOC Children’s Hospital

One-third of all visits to pediatricians are solely for psychological reasons. To support immediate assessment and intervention in primary care, CHOC is providing depression screenings in its own clinics and promoting embedded mental health care in pediatric practices. We also provide depression screenings in the CHOC emergency department.

Mental health triage at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital

Implemented in fall 2016 with public and private funds, the innovative family-based crisis intervention model helps families address mental health crises and is already reducing psychiatric hospitalizations (25 percent reduction) and time spent in the emergency department (17 percent reduction).

CHOC Children’s is taking a leadership role in tackling the pediatric mental health crisis in Orange County. Half of children with symptoms of mental health disorders have conditions that cause significant impairment in daily life. In Orange County, 20 percent of youth reported needing help for mental health problems, while less than a third actually received that help.

Learn more about CHOC’s commitment to mental health

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