Clinical Aspects of Adolescent Endometriosis

Abstract

Early diagnosis and long-term management of endometriosis is important in adolescent girls considering their potential for future pregnancy and need for preventing disease progression. However, symptoms and clinical findings of adolescent endometriosis may differ from those of typical adult endometriosis, making diagnosis difficult. In adolescents, menstrual pain may present as acyclic and unresponsive to commonly used medication. Typical imaging findings in adult endometriosis, such as ovarian endometriotic cysts and fibrotic scars, are less common in adolescents. Peritoneal lesions, characteristic of early-stage endometriosis, are commonly found in this age group. It should be noted that endometriosis may also be found in adolescents before menarche, because of premenarcheal endometriosis or congenital uterine anomaly and outflow obstruction; the latter requiring surgical correction. Although surgery is reported to be effective for pain, postsurgical recurrence rate is high, and the effect of hormonal treatment is controversial. The optimal timing for surgical intervention also remains to be determined. Here, we aim to identify the unique characteristics of endometriosis in adolescents to achieve early diagnosis and optimal management for this group of patients.

Endometriosis: A Review of Clinical Diagnosis, Treatment, and Pathogenesis

“…The etiology of infertility in women with minor or mild endometriosis is less understood. However, it might be linked to a greater prevalence of malformed oocytes, faulty embryos, or unsuccessful implantation [33].…”

“…The etiology of infertility in women with minor or mild endometriosis is less understood. However, it might be linked to a greater prevalence of malformed oocytes, faulty embryos, or unsuccessful implantation [ 33 ]. According to several studies, tall women with low Body Mass Index (BMI) appear at a greater risk of developing endometriosis because they have short menstrual cycles, are more likely to have cervical canalization problems, and decreased germ cell endowment [ 34 ].…”

Use of the Free Endometriosis Risk Advisor App as a Non-Invasive Screening Test for Endometriosis in Patients with Chronic Pelvic Pain and/or Unexplained Infertility

“…It has been estimated that 47% of patients with endometriosis had been seen at least five times by a doctor prior to an endometriosis diagnosis or referral for their symptoms [ 8 ]. Varying presentations, limited access to endometriosis specialists, and reserving surgery as a last resort, especially in adolescents, may contribute to diagnosis delay [ 24 , 25 , 26 , 27 ]. Furthermore, with improved outcomes in Assisted Reproductive Technology (ART), many reproductive endocrinology and infertility specialists are increasingly in favor of clinical diagnosis and medical management versus surgical diagnosis and excision before treatment for unexplained infertility [ 28 , 29 ].…”