Journal of Pediatric and Adolescent Gynecology
ArticleAdolescent Endometriosis: Diagnosis and Treatment Approaches
Introduction
Adolescents frequently complain of dysmenorrhea and pelvic pain. Studies have shown that 25% to 38.3% of adolescents with chronic pelvic pain have endometriosis.1, 2 Traditionally, nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptive pills (OCPs) are the first line of treatment; however, many adolescents continue to describe pelvic pain despite these medications. For these young women, it is important to include endometriosis in the differential diagnosis. Endometriosis in adult women is commonly associated with cyclic pelvic pain; however, the symptoms in adolescents may demonstrate acyclic and cyclic pain. It is estimated that 4% to 17% of postmenarchal females have endometriosis.3 Although in the past it was assumed that endometriosis presented only after many years of menstruation, studies have described endometriosis prior to menarche,4 and 15 and 56 months after menarche. Numerous series have shown rates of endometriosis at 50% to 70% of adolescents undergoing laparoscopy for pelvic pain who did not have control of pelvic pain with OCPs and NSAIDs.7, 8, 9
With education of young women, their families, pediatricians, nurse practitioners, family practitioners, gynecologists, and pediatric surgeons, we may be able to decrease the length of time from the onset of symptoms to presentation, and from the time of presentation to diagnosis. In addition, with early diagnosis of endometriosis it may be possible to decrease the long-term effects of the disease (pain, masses, and infertility), and thus improve affected young women's quality of life.
Section snippets
The Origin of Endometriosis
It is important to note that some patients may have a genetic predisposition towards developing endometriosis. This is suggested by the observation that 6.9% of first-degree female relatives of patients with endometriosis are affected, as compared to 1% or less of controls.10 We commonly see young women in consultation who are brought in by their mothers, who have suffered with endometriosis symptoms since adolescence but were not diagnosed until later in life. Although a tendency to develop
Evaluation of Pelvic Pain
In adult women endometriosis is suspected when a patient presents with chronic pelvic pain, dysmenorrhea, dyspareunia, a pelvic mass, or infertility. In adults the pain of endometriosis is most often cyclic pain. In the adolescent endometriosis population, the presenting pelvic pain is often both acyclic and/or cyclic (see Table 1).9 In addition, bowel and bladder symptoms may be common in adolescents found to have endometriosis.9 Ovarian endometriomas are rare prior to the age range of the
Surgical Treatment
Operative laparoscopy is performed for definitive diagnosis, coagulation, ablation, or resection of endometriosis in the least invasive and most cost-effective fashion. Laparotomy is rarely indicated. Removal of lesions of endometriosis may be performed with electrocautery, endocoagulation, or laser.32 Surgery has been shown to reduce pain from endometriosis in rates of 38% to 100% of adult women.33, 34 Regardless of the technique, care must be taken to avoid damage to the ureters, major
Issues for Future Consideration
Early diagnosis of endometriosis and treatment will hopefully suppress progression and advancement of disease. This is an area that needs future investigation. Additionally, there are some areas that are particularly challenging. For instance, how should we treat the adolescent daughter of a woman who had no pelvic pain but who had Stage IV endometriosis and infertility? Should she have an evaluation and treatment even though she has no pelvic pain, in an attempt to avert the silent development
Conclusions
Evaluation of pelvic pain in adolescents begins with a history and physical exam, pain calendar, laboratory evaluation, and possible ultrasound. Empiric treatment of chronic pelvic pain and dysmenorrhea in adolescents may include nonsteroidal anti-inflammatory agents and hormonal therapy. A definitive diagnosis of endometriosis can only be made by laparoscopy. Forty-five to seventy percent of adolescents with chronic pelvic pain have endometriosis diagnosed at the time of laparoscopy. A
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2021, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :The incidence decreases with age [55,57]. In adolescents, subtle lesions were found in 40% [58] and in 70% [59]. The epidemiology of subtle endometriosis over time does not allow the conclusion that the prevalence has been increasing in recent decades.
Adolescent Endometriosis: An Update
2020, Journal of Pediatric and Adolescent Gynecology