The prevalence, clinical features, diagnosis, and management of endometriosis in adolescent girls has been reviewed in an article published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.
“Endometriosis is frequently described as an enigmatic condition due to many unanswered questions and controversies in its pathogenesis, diagnosis and management,” the clinician writes. In this article, the author gives an overview of the different aspects of the condition from prevalence to clinical features and from diagnosis to treatment, and identifies research needs in this area.
Prevalence of endometriosis
The exact prevalence of endometriosis remains unknown even in adult women and there is a wide variation in the reported prevalence of the condition in available literature. This is likely due to differences in the level of threshold used during surgical or visual diagnosis of the lesions associated with the condition.
The prevalence among adolescents is even less clear since estimates are based on a smaller number of patients. Endometriosis may also be less likely to be diagnosed in adolescents who are younger than 20 compared to older women due to the fact that clinicians as well as patients and their families may not agree to diagnostic surgery at a young age.
However, adolescent endometriosis seems to be more common among adolescents than previously thought and generally be more common among adolescents who have a history of chronic pelvic pain or painful periods that aren’t treatable with medication. Risk factors associated with adolescent endometriosis include early menstruation, a family history of the condition, and developmental defects blocking menstrual flow.
The most common features of endometriosis among adolescents are intense menstrual pain, pelvic pain, excessive straining with bowel movements, constipation, intestinal cramps, exercise pain, and bladder pain.
Although it was previously thought that endometriosis among adolescents were mostly of early stage, more recent reports suggest that adolescent endometriosis is not limited to early forms of the condition but to all stages, including deep endometriosis involving vital structures such as the bowel, ureters, and bladder, and ovarian endometriomas (benign cysts found in the ovaries).
While some studies have shown that adolescent endometriosis can resolve by itself, some researchers think that endometriosis is a progressive disease that starts in teenage years and can progress to deep endometriosis in later life. This underscores the importance of diagnosing and managing adolescent endometriosis as early as possible.
Diagnosis and management
According to the author, the presence of symptoms such as pain that is not solved by medication “should raise the suspicion of endometriosis in adolescents.” An ultrasound can reliably detect ovarian endometriomas but is not helpful in diagnosing superficial endometriosis. Laparoscopy, or surgical diagnosis, remains the gold standard in diagnosing pelvic endometriosis.
Painful periods are usually treated with nonsteroidal anti-inflammatory drugs such as ibuprofen and/or a combined oral contraceptive pill. However, even if a patient responds to these treatments does not rule out endometriosis. Although they can help avoid unnecessary diagnostic procedures such as laparoscopy, they may also mask symptoms of the disease and cause the progression of endometriosis to go undetected.
“Hence, there is an urgent need to start prospective research to establish long-term benefits and potential disadvantages of empirical treatment with [these drugs],” Saridogan wrote.
Drugs known as gonadotrophin-releasing hormone analogues, or GnRHa, may also be used, especially in adolescents whose condition has been confirmed surgically. But the long-term use of these drugs should be carefully considered due to their potential harmful side effects, such as bone density loss.
There is also controversy around the use of surgery to treat adolescent endometriosis. While some doctors seem to think that surgery should be performed as early as possible to avoid the development of more severe lesions, others think that this should be avoided to prevent multiple operations in the long term.
Although there is currently no consensus among doctors as to which treatment approach is the best, the most common approach seems to be the combination of surgery followed by hormone therapy.
“Further research is required to determine which approach would offer a better long term outcome,” Saridogan concluded, adding that new treatment approaches that would be more effective in the long term should also be researched.