Adolescent endometriosis

Abstract

Endometriosis is a common finding in adolescents who have a history of chronic pelvic pain or dysmenorrhoea resistant to medical treatment, however the exact prevalence is unknown. Both early/superficial and advanced forms of endometriosis are found in adolescents, including ovarian endometriomas and deep endometriotic lesions. Whilst spontaneous resolution is possible, recent reports suggest that adolescent endometriosis can be a progressive condition, at least in a significant proportion of cases. It is also claimed that deep endometriosis has its roots in adolescence. Optimum treatment is far from clear and long term recurrence is still a significant problem. The most frequently reported treatment approach in the published literature is a combination of surgery and postoperative hormonal treatment with the combined oral contraceptives, progestins, levonorgestrel intrauterine system or gonadotrophin releasing hormone analogues. Use of gonadotrophin releasing hormone analogues and long term progestins should be carefully considered due to concerns over continuing bone formation in this age group. There is currently no consensus as to whether surgery should be avoided as much as possible to prevent multiple operations in the long term, or surgical treatment should be considered at an early stage before more severe lesions develop. Further research is required to determine which approach would offer a better long term outcome.

Disclosing the invisible: experiences, outcomes and quality of endometriosis healthcare

“…In line with the results of this thesis (study III), women with endometriosis scored significantly lower than controls on SF-36, with young women having the worst HRQoL [116]. The management of adolescent endometriosis is known for its unique challenges, with diverse and sometimes diffuse symptoms and prolonged diagnostic delay [117,118]. Specific structural and process-related strategies aimed at finding and helping these young women at an early age should be considered in the work towards strengthening the quality of endometriosis care.…”

Evaluation of CA125 in relation to pain symptoms among adolescents and young adult women with and without surgically-confirmed endometriosis

“…This inconsistent observation could be due in part to the differences in endometriosis phenotype and age range of the study participants. Prior studies reported CA125 does not perform as well in detecting minimal to mild endometriosis (rASRM stage I/II) [ 30 – 32 ], which is known to be the predominant clinical phenotype of adolescent endometriosis [ 14 , 33 , 34 ]. Furthermore, the average age of endometriosis cases in one prior study was 34 while the average age in our endometriosis cases was 19.6.…”

The role of laparoscopy in paediatric and adolescent gynaecology.

“…In addition, the incidence of endometriosis in the paediatric population increases significantly from 5% to 40% in the presence of defects in the reproductive organs resulting from congenital anomalies in the development of the Mullerian ducts, leading to obstruction of the reproductive organ and disturbance of menstrual drainage [ 79 , 83 , 88 ]. Laparoscopy is the gold standard in the assessment of endometriosis, and in accordance with the guidelines of the American College of Obstetricians and Gynaecologists (ACOG) of 2018 it should be used in the case of persistent pain despite the use of cyclic two-component contraceptive therapy and NSAIDs for a period of 3 months [ 83 , 89 ]. Therefore, laparoscopy is the last diagnostic stage in chronic pelvic pain in the paediatric population.…”