Adolescent endometriosis: the journey to diagnosis

Abstract

OBJECTIVE: To describe the prevalence of endometriosis, time to diagnosis, and referral patterns of adolescent girls with pelvic pain who underwent laparoscopy to determine the etiology of their pain.DESIGN: Descriptive retrospective study.MATERIALS AND METHODS: Thirty-nine adolescent girls with pelvic pain underwent operative laparoscopy between 2001-2009 to determine the etiology of pelvic pain. Nine patients were excluded due to prior surgical diagnosis of endometriosis; five patients were excluded due to radiologic evidence of disease. 25 patients met inclusion criteria.RESULTS: 100% of the study population was found to have endometriosis. Mean age at diagnosis was 17.2 years (range 10-21 years). 72% had cyclic pain, and 28% described acyclic pain. Other associated symptoms included abnormal uterine bleeding (80%), gastrointestinal (68%), and genitourinary (48%) complaints. Mean time from onset of symptoms to diagnosis of endometriosis was 22.8 months (range 1-132 months) The average number of physicians seen for these symptoms was 2.7 (range 0-12) and included one or more gynecologist (60%), gastroenterologist (36%), internist (16%), urologist (16%), and general surgeon (8%). Other specialists seen included pediatric surgery, pain specialist, psychiatry and orthopedic surgery. 32% reported at least one emergency room visit. Other diagnoses previously considered include PID (12%), irritable bowel syndrome (12%), Crohn's Disease (8%), ovarian cysts (12%), appendicitis (8%), orthopedic issue (8%), and IC (8%). 12% had a prior provisional diagnosis of endometriosis, though none were treated for it.CONCLUSIONS: Adolescents with pelvic pain and no other radiologic evidence of pathology have a high rate of endometriosis. Incorrect diagnoses continue to cause delays in diagnosis and management, and evaluation by various subspecialists. Endometriosis should be considered in this population with timely referral to gynecologists who are experienced with laparoscopic diagnosis of endometriosis. OBJECTIVE: To describe the prevalence of endometriosis, time to diagnosis, and referral patterns of adolescent girls with pelvic pain who underwent laparoscopy to determine the etiology of their pain. DESIGN: Descriptive retrospective study. MATERIALS AND METHODS: Thirty-nine adolescent girls with pelvic pain underwent operative laparoscopy between 2001-2009 to determine the etiology of pelvic pain. Nine patients were excluded due to prior surgical diagnosis of endometriosis; five patients were excluded due to radiologic evidence of disease. 25 patients met inclusion criteria. RESULTS: 100% of the study population was found to have endometriosis. Mean age at diagnosis was 17.2 years (range 10-21 years). 72% had cyclic pain, and 28% described acyclic pain. Other associated symptoms included abnormal uterine bleeding (80%), gastrointestinal (68%), and genitourinary (48%) complaints. Mean time from onset of symptoms to diagnosis of endometriosis was 22.8 months (range 1-132 months) The average number of physicians seen for these symptoms was 2.7 (range 0-12) and included one or more gynecologist (60%), gastroenterologist (36%), internist (16%), urologist (16%), and general surgeon (8%). Other specialists seen included pediatric surgery, pain specialist, psychiatry and orthopedic surgery. 32% reported at least one emergency room visit. Other diagnoses previously considered include PID (12%), irritable bowel syndrome (12%), Crohn's Disease (8%), ovarian cysts (12%), appendicitis (8%), orthopedic issue (8%), and IC (8%). 12% had a prior provisional diagnosis of endometriosis, though none were treated for it. CONCLUSIONS: Adolescents with pelvic pain and no other radiologic evidence of pathology have a high rate of endometriosis. Incorrect diagnoses continue to cause delays in diagnosis and management, and evaluation by various subspecialists. Endometriosis should be considered in this population with timely referral to gynecologists who are experienced with laparoscopic diagnosis of endometriosis.