031 Medical and surgical management of endometriosis in teenagers

Abstract

Menstrual symptoms such as dysmenorrhea are frequently reported, both in adults as in the adolescent population. A significant number of high school students report missed school days due to menstrual symptoms. Endometriosis is associated with painful menstruation and chronic pelvic pain. It’s true prevalence in the adolescent population is unknown, although 2/3rds of laparoscopies performed for pelvic pain in adolescents show endometriosis. Before discussing treatment, it is vital that severe menstrual pain is not regarded as normal, and should warrant further medical advice (which may include ultrasound) in case it has an impact on school and social activities, to reduce diagnostic and treatment delay. Treatment of endometriosis-associated pain may be medical and/or surgical, although data in the adolescent population are scarce. First line medical treatment can be offered with NSAIDs, and where appropriate hormonal treatment such as combined oral contraceptives or progestogens. Although GnRH-analogues have shown to be effective for pain treatment, they should be used very restrictively and with great caution due to their side effects and reduction of (peak) bone mineral density. Surgical treatment can be offered in case of pain not responding to hormonal treatment, or in case large cysts or bowel/ureter obstruction is found. Laparoscopy should be performed by an experienced team, to avoid repeat surgery and its associated risks. Postoperative hormonal treatment is advised to reduce recurrence rates.