Progress in the diagnosis and management of adolescent endometriosis: an opinion

Abstract

Increasing evidence indicates that early onset endometriosis (EOE), starting around menarche or early adolescence, may have an origin different from the adult variant, originating from neonatal uterine bleeding (NUB). This implies seeding of naïve endometrial progenitor cells into the pelvic cavity with NUB; these can then activate around thelarche. It has its own pathophysiology, symptomatology and risk factors, warranting critical management re-evaluation. It can also be progressive, endangering future reproductive capacity. This variant seems to be characterized by the presence of ovarian endometrioma. Today, the diagnosis of endometriosis in young patients is often delayed for years; if rapidly progressive, it can severely affect pelvic organs, even in the absence of serious symptoms. Given the predicament, great attention must be paid to symptomatology that is often non-specific, justifying a search for new, simple, non-invasive markers of increased risk. Better use of modern imaging techniques will aid considerably in screening for the presence of EOE. Traditional laparoscopy should be limited to cases in which imaging gives rise to suspicion of severity and a stepwise, minimally invasive approach should be used, followed by medical treatment to prevent recurrence. In conclusion, EOE represents a condition necessitating early diagnosis and stepwise management, including medical treatment.

Use of dienogest in endometriosis: a narrative literature review and expert commentary

“…Endometriosis affects a significant proportion of adolescent girls, but diagnostic delays are common in this population 109,110 , partially due to the differences in clinical presentation compared with adults. These delays can partly explain the severity of disease affecting these younger patients and support the need for a simple, noninvasive tool for the screening of endometriosis in this population 110 . It is important that physicians recognize endometriosis in younger patients so timely treatment can be given 109 .…”

“…Receiving a diagnosis of endometriosis can provide some reassurance to adolescent patients regarding the cause of their pain, but it can also cause anxiety upon learning that it may require long-term treatment and surgery, and may cause infertility; therefore, scheduling frequent follow-up visits is important. Current surgical treatment options have potential deleterious effects on the ovarian follicle reserve, and some studies have suggested a recurrence rate of up to 56% in adolescent patients with endometriosis 110 . As it stands, a conservative treatment approach, avoiding surgery, is desirable, and hormonal therapies and analgesics are recommended for relief of endometriosis-related pain 2 .…”

The role of laparoscopy in paediatric and adolescent gynaecology.

“…It is known that endometriosis affects 73% of adolescents and adult women with a history of primary dysmenorrhoea [ 84 ], while 62% of adolescents with chronic pelvic pain or dysmenorrhoea are diagnosed with endometriosis during diagnostic laparoscopy [ 85 , 86 ]. The incidence of endometriosis in girls with chronic pelvic pain increases with age [ 79 ], while there is no correlation between the progression of endometriosis and age [ 87 ], and pelvic pain in girls with endometriosis does not correlate with the clinical stage of the disease – it can show high intensity in both minimal and high-degree endometriosis [ 79 ]. In addition, the incidence of endometriosis in the paediatric population increases significantly from 5% to 40% in the presence of defects in the reproductive organs resulting from congenital anomalies in the development of the Mullerian ducts, leading to obstruction of the reproductive organ and disturbance of menstrual drainage [ 79 , 83 , 88 ].…”

Causes and mechanisms of endometriosis: an update

“…Считается, что ретроградный кровоток является источником эктопического эндометрия при раннем эндометриозе, начинающемся сразу с появлением менархе и телархе в раннем подростковом возрасте. Ранний эндометриоз может иметь происхождение, отличное от взрослого варианта, в основе развития заболевания могут быть маточные кровотечения у новорожденных [22].…”