Adolescent endometriosis in the Waikato region of New Zealand--a comparative cohort study with a mean follow-up time of 2.6 years

Abstract

Study objective: To describe our experience with laparoscopic excision of endometriosis on an adolescent population and to compare it with a non-adolescent population treated during the same period.

Design: Comparative cohort study of patients with endometriosis treated consecutively between July 2003 and January 2009 with a follow-up between six months and six years.

Setting: Braemar Hospital, Hamilton, New Zealand.

Results: We treated 20 adolescents. Ninety-five per cent (19/20) of adolescents were using pain relief other than Paracetamol, in contrast to only 59% (84/143) of non-adolescents. Thirty per cent (6/20) of adolescents had a first-degree relative with endometriosis, in contrast to 8% (11/143) of non-adolescents. Endometriosis was found to be stage I in 40% (8/20) of patients, stage II in 45% (9/20) of patients, stage III in 5% (1/20) of patients and stage IV in 10% (2/20) of patients. The main type of endometriotic lesion in the adolescent was an atypical red vascular lesion, which was present in 60% (12/20) of adolescents; but it was present in only 20% (29/143) of non-adolescents. There were no intra-operative complications. Minor postoperative complications included one case of urinary tract infection and one case of port infection. The operative complications that developed when treating the non-adolescent group are presented for comparison. Pain scores recorded at follow-up revealed a significant reduction in dysmenorrhoea and pelvic pain and there was a positive effect on the quality of life of adolescents as measured by the EQ-5D questionnaire tool.

Conclusion: Adolescents with endometriosis use significantly more pain relief than non-adolescents to control symptoms. They have a higher rate of a first degree relative with the disease and they present with more atypical endometriotic lesions when compared with an adult population with endometriosis. All the stages of disease are present in the adolescent, including stages III and IV. The laparoscopic excision of endometriosis has a positive effect on the relief of pain symptoms and on the improvement in quality of life in the adolescent.