Adolescent endometriosis: prevalence increases with age on magnetic resonance imaging scan

Millischer, Anne-Élodie; Santulli, Piétro; Costa, Sabrina Da; Bordonné, Corinne; Cazaubon, Elise; Marcellin, Louis; Chapron, Charles

doi:10.1016/j.fertnstert.2022.12.039

Cited by 20 publications

(15 citation statements)

References 49 publications

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“…This evidence is also supported by the experience of Millischer et al In their study, the prevalence of endometriosis increases with age, with a significant threshold at the age of 18 [ 5 ].…”

Section: Introductionsupporting

confidence: 72%

Investigating Unhealthy Behaviors Associated with SF-36 Domains in Women with Endometriosis—Findings from a Web-Based Survey Data Set

Muselli,

Mancinelli,

Limoncin

et al. 2024

Behavioral Sciences

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Unhealthy behaviors may contribute to the development and the progression of chronic diseases with negative consequences on patients’ quality of life. The present study aimed to investigate the relationship between unhealthy behaviors (physical inactivity, tobacco consumption, and alcohol consumption) and health-related quality of life, measured with the SF-36 questionnaire, in women with endometriosis. To achieve this, data from a previous cross-sectional web survey among Italian adult women were analyzed. A total of 1045 responses were included in the analysis. Among the SF-36 subscales, the lowest score was recorded in the energy/fatigue domain: mean = 35.536 (Standard Deviation = 18.452). Smoking and physically inactive women had lower scores than non-smoking and physically active women, respectively, in each SF-36 domain. Women who drank more than one unit of alcohol a day, on average, reported lower scores than women with an alcohol intake <1 unit a day, for the following SF-36 domains: role limitations due to physical health, role limitations due to emotional problems, and emotional well-being. The multivariable analysis evidenced that employment, physical inactivity, and tobacco consumption were significant predictors for each SF-36 domain (p < 0.05). Physical inactivity and tobacco consumption had negative effects on the SF-36 subscales. Our results showed the need to monitor unhealthy behaviors to improve the overall well-being of women with endometriosis. Tailored strategies addressing smoking cessation, promoting physical activity, and moderating alcohol intake may aid in enhancing health-related quality of life in this vulnerable population.

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Section: Introductionsupporting

confidence: 72%

Investigating Unhealthy Behaviors Associated with SF-36 Domains in Women with Endometriosis—Findings from a Web-Based Survey Data Set

Muselli,

Mancinelli,

Limoncin

et al. 2024

Behavioral Sciences

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“…From an evolutionary point of view, should not anovulation and amenorrhoea still be considered the physiological state at least during the early reproductive years? If ROM, especially during adolescence, defined here as the period between 12 and 20 years of age ( Martire et al , 2020 ; Millischer et al , 2023 ), has an impact on the likelihood of the development and progression of endometriosis and adenomyosis, then there could be an opportunity to use hormonal interventions in secondary prevention selectively in individuals with disabling pelvic pain to reduce the burden of exposure to one of the well-established risk factors for these two conditions ( Fathalla, 2019 ; Bulun et al , 2019 , 2021 ; Munro, 2023 ).…”

Section: Prospectus: Preventive Interventional Endocrinology?mentioning

confidence: 99%

“…Different pathogenic hypotheses have also been suggested for adenomyosis, but awareness and interest in the condition have only recently increased and diagnostic capabilities are rapidly improving. This has led to a change in the epidemiological scenario and adenomyosis is now considered to be a disease not only of parous menstruators in their forties, but also of young menstruators ( Martire et al , 2020 ; Bulun et al , 2021 ; Guo 2023 ; Millischer et al , 2023 ).…”

Section: Introduction: Connecting the Dotsmentioning

confidence: 99%

“…The underlying concept remains the notion of repetitive ovulatory menstruation (ROM) as a source of reiterative bleeding and thus as a direct or indirect spring of iron-induced oxidative stress and secondary chronic inflammation ( Van Langendonckt et al , 2002a , b ; Lousse et al , 2009 , 2012 ; Donnez et al , 2016 ; Bulun et al , 2019 , 2021 ; Wyatt et al , 2023 ). However, whereas the ovarian cancer model takes into account the total number of ovulatory menstrual cycles over the entire reproductive period ( Eaton et al , 1994 , 2002 ; Fu et al , 2022 ), and thus the lifetime pelvic exposure to blood, in the case of endometriosis and adenomyosis the focus is on early postmenarchal exposure ( Kvaskoff et al , 2013 ; Martire et al , 2020 ; Bulun et al , 2021 ; Millischer et al , 2023 ). Epidemiological and endocrinological factors will be interpreted here in the light of recent changes in menstrual and reproductive patterns ( Short, 1976 , 1994 ; Thomas and Ellertson, 2000 ; Renfree, 2012 ; Fathalla, 2019 ).…”

Section: Introduction: Connecting the Dotsmentioning

confidence: 99%

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Proposal for targeted, neo-evolutionary-oriented, secondary prevention of early-onset endometriosis and adenomyosis. Part I: pathogenic aspects

Vercellini,

Bandini,

Viganò

et al. 2023

Human Reproduction

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The potential for repeated ovulation and menstruation is thought to have provided a Darwinian advantage during the Palaeolithic. Reproductive conditions remained relatively stable until the pre-industrial era, characterized by late menarche, very young age at first birth, multiple pregnancies, and prolonged periods of lactational amenorrhoea. For hundreds of thousands of years, menstruators experienced few ovulatory cycles, even though they were genetically adapted to ovulate and menstruate every month. In the post-industrial era, the age at menarche gradually declined, the age at first birth progressively increased, and breastfeeding became optional and often of short duration. This created a mismatch between genetic adaptation and socio-environmental evolution, so that what was initially a probable reproductive advantage subsequently contributed to increased susceptibility to diseases associated with lifetime oestrogen exposure, such as ovarian, endometrial and breast cancer and, hypothetically, also those associated with the number of ovulatory menstruations, such as endometriosis and adenomyosis. The incidence of endometriosis shows a steep and progressive increase around the age of 25 years, but given the consistently reported delay in diagnosis, the actual incidence curve should be shifted to the left, supporting the possibility that the disease has its roots in adolescence. This raises the question of whether, from an evolutionary point of view, anovulation and amenorrhoea should not still be considered the physiological state, especially in the postmenarchal period. However, an increase in the frequency of endometriosis in recent decades has not been demonstrated, although this deserves further epidemiological investigation. In addition, as endometriosis occurs in a minority of individuals exposed to retrograde menstruation, other important pathogenic factors should be scrutinised. Research should be resumed to explore in more detail the transtubal reflux of not only blood, but also endometrial cells, and whether they are systematically present in the peritoneal fluid after menstruation. If repetitive ovulatory menstruation during the early reproductive years is shown to increase the risk of endometriosis and adenomyosis development and progression in susceptible individuals, hormonal interventions could be used as secondary prevention in symptomatic adolescents.

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“…24 Magnetic resonance imaging may be a subsequent step to further delineate a reproductive tract anomaly, though severe endometriosis phenotypes (ovarian endometriomas and deep infiltrating endometriosis) may be seen using this modality in adolescents predominantly after age 18 years. 25 Further research regarding magnetic resonance imaging and its cost effectiveness as a diagnostic tool in adolescents is needed before recommendations supporting its routine use can be made for this purpose. The majority of examinations and pelvic imaging often yield negative results, 26,27 which nonetheless do not rule out the possibility of endometriosis, especially in cases involving superficial peritoneal lesions or adhesions.…”

Section: Examination and Imagingmentioning

confidence: 99%

Evaluation and Management of Endometriosis in the Adolescent

Shim,

Laufer,

King

et al. 2023

Obstetrics &Amp; Gynecology

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Endometriosis is a chronic condition, with debilitating symptoms affecting all ages. Dysmenorrhea and pelvic pain often begin in adolescence, affecting school, daily activities, and relationships. Despite the profound burden of endometriosis, many adolescents experience suboptimal management and significant delay in diagnosis. The symptomatology and laparoscopic findings of endometriosis in adolescents are often different than in adults, and the medical and surgical treatments for adolescents may differ from those for adults as well. This Narrative Review summarizes the diagnosis, evaluation, and management of endometriosis in adolescents. Given the unique challenges and complexities associated with diagnosing endometriosis in this age group, it is crucial to maintain a heightened level of suspicion and to remain vigilant for signs and symptoms. By maintaining this lower threshold for consideration, we can ensure timely and accurate diagnosis, enabling early intervention and improved management in our adolescent patients.

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Adolescent endometriosis: prevalence increases with age on magnetic resonance imaging scan

Cited by 20 publications

References 49 publications

Investigating Unhealthy Behaviors Associated with SF-36 Domains in Women with Endometriosis—Findings from a Web-Based Survey Data Set

Investigating Unhealthy Behaviors Associated with SF-36 Domains in Women with Endometriosis—Findings from a Web-Based Survey Data Set

Proposal for targeted, neo-evolutionary-oriented, secondary prevention of early-onset endometriosis and adenomyosis. Part I: pathogenic aspects

Evaluation and Management of Endometriosis in the Adolescent

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