Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy

Abstract

Study objective: To evaluate adolescent girls with chronic pelvic pain not responding to conventional medical therapy, using advances in operative laparoscopy to determine endometriosis prevalence, clinical stage, and type of lesion.

Design: A descriptive retrospective study of subjects who (1) were referred for the evaluation of chronic pelvic pain, (2) did not respond to a nonsteroidal anti-inflammatory drug and an oral contraceptive pill, and (3) underwent a laparoscopy to determine the etiology of the pelvic pain.

Setting: Patients referred to a surgical gynecologist in a pediatric/adolescent gynecology and reproductive endocrine academic practice.

Participants: All patients younger than 22 years of age with chronic pelvic pain.

Intervention: Operative laparoscopy to determine the etiology of the chronic pelvic pain.

Main outcome measures: Operative laparoscopy results including stage and description of endometriosis.

Results: More than two thirds of the study population (69.6%) was found to have endometriosis. All subjects had either stage I or II as determined by the American Fertility Society's classification system. The nature of the pain in the 32 subjects with endometriosis was both acyclic and cyclic in 20 (62.5%), acyclic only in 9 (28.1%), and cyclic only in 3 (9.4%). Other presenting symptoms included gastrointestinal in 11 (34.3%), urinary in 4 (12.5%), and irregular menses in 3 (9.4%).

Conclusions: Adolescents with chronic pelvic pain not responding to medical therapy have a high rate of endometriosis and should be referred to a gynecologist who is experienced with the subtle laparoscopic findings of atypical endometriosis to diagnose the etiology of the pelvic pain and initiate appropriate therapy.