Features of endometriosis in adolescent girls: difficulties in diagnosis and prevention of complications

Abstract

Introduction. Endometriosis is an estrogen–dependent disease characterized by the spread of endometrial-like tissue outside the uterine cavity. Symptoms of the disease appear after menarche, in adolescence. The symptoms of endometriosis often go unnoticed and underestimated in early age, which leads to a delay in the beginning of therapy and the progression of the disease. The difficulty of diagnosing of endometriosis in adolescents is determined not only by the specificity of the clinical picture, but also by the lack of generally accepted markers for detecting the disease, as well as the difficulty of identifying initial forms using imaging techniques such as ultrasound, MRI. The purpose of this review is to identify the age-related features of endometriosis, especially in children and adolescents, to provide early diagnosis of the disease and timely initiation of the treatmen. Endometrial foci in adolescents look different from adults. As a rule, merging vesicular or papular, transparent, red and white lesions are more characteristic than black or blue ones for this age group. While in adult women, the foci of endometriosis are black with pronounced fibrosis. Histological examination after laparoscopic surgery remains the gold standard for confirming the diagnosis, although the results of these studies may not always correspond to each other. Microscopic examination reveals areas of fibrous, fatty, muscular tissue, hemorrhages, vessels, areas of calcification and infiltration by multinucleated leukocytes, as well as a combination of endosalpingiosis and endometriod-like tissues. Moreover, it is important to carry out differential diagnosis with chronic pelvic pain, as well as with abnormalities in development, pathologies of the gastrointestinal tract, adenomyosis. Conclusion. Thus, endometriosis is an estrogen-dependent disease affecting more than 10% of women of reproductive age. However, often the symptoms of the disease go unnoticed in adolescence, which leads to the progression of the disease in the future in women. Timely diagnosis of endometriosis plays an important role in preventing the development of complications and eliminating infertility in the future.