Is this me?

The count

Source for the seven: ESHRE guideline 2022, adolescents. This is a count of what was ticked, not a score, and it cannot say whether anyone has the disease.

“In adolescents, clinicians should take a careful history and consider the following symptoms as suggestive of the presence of endometriosis: chronic or acyclical pelvic pain, particularly combined with nausea, dysmenorrhoea, dyschezia, dysuria, dyspareunia; cyclical pelvic pain.”
strong recommendation · very-low-quality evidence ESHRE guideline 2022, adolescentsDysmenorrhoea is period pain; dyschezia is pain emptying the bowel; dysuria is pain passing urine; dyspareunia is pain with sex; acyclical means not tied to the period.

“Most adolescents experiencing dysmenorrhea have primary dysmenorrhea” ACOG Committee Opinion 760, 2018 (since replaced by ACOG's 2026 guideline)In plain words: most teenagers with painful periods do not have endometriosis. That is why the guidelines ask doctors to look for these features, rather than assume either way.

“If you experience one or more of these symptoms and they cause you (severe) pain, you should go to your family doctor and ask him to consider endometriosis.” ESHRE patient guideline, 2022The leaflet’s adolescent list, in full: chronic or acyclical pelvic pain, particularly combined with nausea, painful periods, pain emptying the bowel or bladder, pain during or after sex; cyclical pelvic pain; and (cyclical) absence from school.

The wait

the range ACOG cites for the average wait before a diagnosis, in women who got one

Women who were eventually diagnosed report long waits: ACOG cites a range of 4 to 11 years on average, and the largest recent cohort, nearly 7,000 French women who reported a diagnosis of endometriosis or adenomyosis, put it at 10, against the 7 years its authors say is commonly described. All of it was measured in women diagnosed years ago. Nobody is standing in a fixed queue, and the guidelines do not ask anyone to wait for surgery to be treated.

Sources: ACOG press release, 2026 · ComPaRe cohort, France, 2026.

In one small trial (about 20 adult women), untreated disease had progressed in 45% by six months; in about one in five it had improved on its own. Abbott et al., placebo-controlled trial, 2004

The others

symptoms began before 15   between 15 and 19   grey: 20 or later

Two figures, both traced to the US Endometriosis Association, a patient body whose registry its founder described in 2004 as over 7,000 confirmed cases: about two in three women diagnosed in adulthood said their symptoms began before 20, and 38 in 100 before 15. The association's own reports are not freely readable online, so the figures here are as quoted by a 2020 open-access review (which cites the association's 1998 survey) and by Endometriosis Australia (which cites the founder's 2003 report). Members of a patient association are not every woman with the disease.

100 dots, each standing for one woman in a hundred; none of them is you. Sources: 2020 open-access review (Sieberg et al.), quoting the two-thirds figure · Endometriosis Australia, adolescent page, quoting the 38% · Ballweg 2003, the registry report (abstract not available) · Ballweg 2004, "over 7000 confirmed cases".

The clock

“Most adolescents who present with dysmenorrhea have primary dysmenorrhea and will respond well to empiric treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or hormonal suppression, or both.” ACOG Committee Opinion 760, 2018 (since replaced by ACOG's 2026 guideline)Empiric treatment means treating on the strength of the history and examination, before a scan or surgery confirms the cause.

“In adolescents with severe dysmenorrhoea and/or endometriosis-associated pain, clinicians should prescribe hormonal contraceptives or progestogens (systemically or via LNG-IUS) as first-line hormonal hormone therapy because they may be effective and safe. However, it is important to note that some progestogens may decrease bone mineral density.”
strong recommendation · very-low-quality evidence ESHRE guideline 2022, adolescentsLNG-IUS is a hormonal coil placed in the womb. Bone mineral density is bone strength; it matters most while bones are still growing, which is why the guideline adds the caveat.

“The GDG recommends clinicians consider NSAIDs as treatment for endometriosis-associated pain in adolescents with (suspected) endometriosis, especially if first-line hormone treatment is not an option.”
good practice point ESHRE guideline 2022, adolescentsGDG is the guideline development group. NSAIDs are anti-inflammatory painkillers such as ibuprofen or naproxen. A good practice point rests on the group’s clinical experience rather than on trials.

“When a patient does not experience clinical improvement for her dysmenorrhea within 3–6 months of therapy initiation, her obstetrician–gynecologist should investigate for possible secondary causes and for treatment adherence.” ACOG Committee Opinion 760, 2018 (since replaced by ACOG's 2026 guideline)Secondary causes means a condition behind the pain, and endometriosis is the one the same document calls 'the leading cause of secondary dysmenorrhea in adolescents'. Treatment adherence means checking the medicine was actually taken as prescribed, which a doctor will ask about.

“In adolescents with suspected endometriosis where imaging is negative and medical treatments (with NSAIDs and/or hormonal contraceptives) have not been successful, diagnostic laparoscopy may be considered.”
weak recommendation · low-quality evidence ESHRE guideline 2022, adolescentsNSAIDs are anti-inflammatory painkillers such as ibuprofen. A laparoscopy is keyhole surgery to look inside.

Among girls whose pelvic pain had resisted treatment and who went on to keyhole surgery, 75% (237 of 314) were found to have endometriosis. The review that pooled these studies warns the figure may be an overestimate, and it says nothing about girls who never had surgery. Janssen et al., systematic review, 2013

“A presumptive diagnosis of endometriosis based on patient history, symptoms, and physical examination findings—what we call a clinical diagnosis—allows us to offer patients empiric medical treatment while we continue the evaluation process with imaging studies, enabling patients to feel better faster and connect them with resources and support sooner.” Bliss Kaneshiro MD, named author of ACOG Clinical Practice Guideline 11, in ACOG's press release, February 2026Empiric treatment means treating on the strength of the history and examination, before a scan or surgery confirms the cause.

The word