Medical and Behavioral Aspects of Adolescent Endometriosis: A Review of the Literature

Abstract

The majority of young women will experience discomfort associated with menstrual cycles and miss out on education and social opportunities. Endometriosis, the presence of endometrial glands and stroma outside of uterus, is the most common cause of secondary dysmenorrhea and characterized by pain despite treatment with nonsteroidal anti-inflammatory drugs and hormonal agents. The true prevalence of adolescent endometriosis is not clear. Delay in diagnosis leads to persistent pain, affects quality of life, and potentially contributes to disease progression and subfertility. A laparoscopic diagnosis is the gold standard, but the surgical appearance may differ from adults, as endometriotic lesions are usually red or clear, making their identification a challenge for gynecologists who are unexperienced with endometriosis in adolescents. A personalized medical–surgical treatment is regarded as the most effective therapeutic strategy to achieve remission of symptoms, suppress disease progression, and protect future fertility. Studies have demonstrated how adolescent endometriosis negatively affects patients’ quality of life and psychosocial functioning. Development of therapeutic interventions targeting psychosocial function and quality of life is imperative for adolescent patients.

Pelvic Pain, Mental Health and Quality of Life in Adolescents with Endometriosis after Surgery and Dienogest Treatment

“…The results of conducted multivariate analysis linked CRP levels to the VAS score and estradiol levels to the McGill pain index. Our data fit into the conception that estrogen-induced neuro-immune interaction plays a key role in peripheral sensitization while enhancing EMS-associated neuropathic pains [ 24 , 25 , 26 ].…”

“…Estradiol is known to directly stimulate prostaglandin E2 synthesis, thereby enhancing noxious stimuli in a COX2-dependent manner [ 23 ]. Many studies associate EMS with increased levels of IL-1β, IL-6, IL-8, TNF-α, CCL-2, CCL-5, and VEGF in systemic circulation and peritoneal fluid [ 3 , 24 , 25 , 26 ]. Due to the central role of pro-inflammatory cytokines in the clinical picture of the disease, non-steroidal anti-inflammatory drugs (NSAIDs) remain first-line painkillers in their management.…”

Deep Infiltrating Endometriosis in Adolescence: Early Diagnosis and Possible Prevention of Disease Progression

“…Indeed, some prenatal factors may also be associated with the onset of DIE in adolescence, such as preeclampsia and low birth weight [21]. The underlying mechanism would be the fetal hypoxic environment caused by placental insufficiency that would increase endometrial sensitivity to progesterone [23] and the altered platelet activation leading to augmented angiogenesis [13]. It is hypothesized that the presence of a fetal hormonal milieu then facilitates the development of DIE [24].…”

Association between KRAS and PIK3CA Mutations and Progesterone Resistance in Endometriotic Epithelial Cell Line

“…Endometriosis causes dysmenorrhea, chronic pelvic pain, dyspareunia, painful defecation, and infertility [1]. Its epidemiology is still controversial; however, it has been reported that 10-15% of women of reproductive age suffer from endometriosis [2][3][4][5]. Endometriosis-related pain is severe in many cases and causes school absenteeism among adolescents and has a severe impact on work productivity [6,7].…”