Endometriosis in adolescents

Abstract

Background and objectives: Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to describe the experience of adolescents who underwent laparoscopy for pelvic pain and were diagnosed with endometriosis: specifically, the symptoms, time from onset of symptoms to correct diagnosis, number and type of medical professionals seen, diagnosis, treatment, and postoperative outcomes.

Methods: We reviewed a series of 25 females ≤21 years of age with endometriosis diagnosed during laparoscopy for pelvic pain over an 8-year period. These patients were followed up for 1 year after surgery.

Results: The mean age at the time of surgery was 17.2 (2.4) years (range, 10-21). The most common complaints were dysmenorrhea (64%), menorrhagia (44%), abnormal/irregular uterine bleeding (60%), ≥1 gastrointestinal symptoms (56%), and ≥1 genitourinary symptoms (52%). The mean time from the onset of symptoms until diagnosis was 22.8 (31.0) months (range, 1-132). The median number of physicians who evaluated their pain was 3 (2.3) (range, 1-12). The adolescents had stage I (68%), stage II (20%), and stage III (12%) disease. Atypical endometriosis lesions were most commonly observed during laparoscopy. At 1 year, 64% reported resolved pain, 16% improved pain, 12% continued pain, and 8% recurrent pain.

Conclusions: Timely referral to a gynecologist experienced with laparoscopic diagnosis and treatment of endometriosis is critical to expedite care for adolescents with pelvic pain. Once the disease is diagnosed and treated, these patients have favorable outcomes with hormonal and nonhormonal therapy.

Keywords: Adolescent endometriosis; Atypical endometriosis; Endometriosis; Pelvic pain; Referral pattern.

Figure 1.

The selection process for the study.

Figure 2.

Peritoneal defect (arrow) with red, punctate lesions in the center of the defect in the right ovarian fossa in a 16-year-old patient with stage II endometriosis.

Figure 3.

Hemorrhagic endometriosis (arrow) involving the left pelvic sidewall with an atypical white fibrotic endometriosis lesion (double arrow) immediately over the left ureter and left ovarian fossa in a 16-year-old patient with stage II endometriosis.

Figure 4.

Atypical clear endometriosis lesions studding the peritoneum of the posterior cul-de-sac. The clear, vesicular, superficial lesions (arrow) were found in an 18-year-old patient with stage I endometriosis who had a family history of the disease.

Figure 5.

Cortical endometriosis lesions (arrow) on the left ovary in a 15-year-old patient with stage III endometriosis.

Figure 6.

Scattered variable-appearing endometriosis lesions with severe disease in the left pelvis. The endometriosis invaded the retroperitoneal fibroadipose tissue of the left posterior cul-de-sac and also involved the left paraureteral region. This extensive disease presentation was found in a 15-year-old patient with stage III endometriosis (the patient shown in Figure 5).

Figure 7.

Hemorrhagic red endometriosis lesions involving the left broad ligament and perivesicular peritoneum in a 20-year-old patient with stage II endometriosis.