Comorbidities in Adolescents With Endometriosis

Abstract

for treatment of biopsy proven endometriosis, and determine it's efficacy in regards to pain and bleeding on follow up exam. Methods: This was a retrospective chart review of adolescent patients with pathology proven endometriosis who had a LNG-IUS placed for treatment during the time period of October 2009 through June of 2011. Patients were either classified as having the LNG-IUS placed at the time of diagnostic laparoscopy, or after the diagnosis had been made. Hormonal medications used before and after diagnosis of endometriosis were recorded. Follow up visits after LNG-IUS insertion were reviewed for the presence of persistent pain and bleeding. Additional hormonal medications needed after LNG-IUS insertion to control pain and bleeding were also recorded. Results: Eighteen patients, with median age of 16, were identified with pathology proven endometriosis who had a LNG-IUS placed as part of their treatment. Seventeen patients had stage I disease, and one patient had stage II disease. LNG-IUS was placed at time of diagnostic procedure in 8 patients, and the remaining 10 patients had the LNG-IUS placed after diagnosis (mean of 25.6 months). In the eight patients that had an LNG-IUSplaced at the time of diagnosis, all but one patient required additional hormonal medications for pain or bleeding suppression. Two patients required GnRHa, and the remaining 5 patients used an oral contraceptive or progestin for an average of 6.6 months. Length of follow up after LNG-IUS was an average of 8.5 months. Time until bleeding cessation was an average 4.2 months in six patients, with the remaining two patients having irregular spotting at the last visit. All eight patients had pain resolution within an average of 4.75 months. In the ten patients that had the LNG-IUS placed after surgery, all had post operative hormonal therapy up until the time of LNG-IUS insertion. Eight patients were treated with GnRHa, while the remaining were treated with an oral contraceptive or progestin. After insertion of the LNG-IUS, five patients needed no additional medication for pain or bleeding, while the other five were treated with an oral contraceptive or progestin (4 patients) or GnRHa (1 patient). Of the patients in this groupwith at least 3months of follow up, all had resolution of bleeding by an average of 2.3 months. All but one patient had resolution of pain within an average of 4.8 months. Conclusions: An LNG-IUS is an option for treatment of endometriosis in adolescents. Our study indicates that the majority of patients (67%) will require additional hormonal therapy for pain and bleeding suppression. Average time to pain suppression was similar in both groups (4.8 versus 4.75 months). As pain is the main problem associated with endometriosis, it can be beneficial to consider LNG-IUS placement at the time of diagnostic surgery.