Endometriosis and Pelvic Pain in the Adolescent: Delayed Diagnosis Leading to Long-Term Suffering and the Need for Intervention

Abstract

<h3>Study Objective</h3> To discuss the atypical presentation of endometriosis in adolescents, importance of decreasing delays in diagnosis and management and reducing long-term suffering in our adolescent population <h3>Design</h3> Narrative Review. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> A database search was performed using MEDLINE/PubMed and CINAHL Plus. Keywords included, adolescent endometriosis, pelvic pain adolescents, secondary dysmenorrhea in adolescents, adolescent endometriosis presentation, adolescent endometriosis management. The committee opinion from the American College of Obstetrics and Gynecologists on dysmenorrhea and endometriosis in the adolescent was utilized. A manual search from reference lists of relevant articles was conducted. Endometriosis is the most common cause of secondary dysmenorrhea in adolescents. Delay in diagnosis of endometriosis in adolescents, continues to be a barrier in early intervention and management, leading to chronic pelvic pain and long-term suffering well into adulthood. Atypical presentation of endometriosis in adolescents contributes to the delay in diagnosis. In adolescents, endometriotic lesions present as red, clear, white, or glandular lesions rather than the powder burn lesions seen in adult women. Additionally, adolescents develop non-cyclical pain, not the classic cyclic pain associated with endometriosis. Pelvic ultrasounds and Magnetic Resonance Imaging are helpful in diagnosis, however laparoscopy remains the gold standard, even in adolescents, because the likelihood of discovering endometriosis in an adolescent presenting with dysmenorrhea and chronic pelvic pain refractory to medical therapy is at least 50%. Hormonal therapy, NSAIDs, GNRHa and, surgical management with postoperative hormonal therapy are the recommended treatments for adolescent patients. <h3>Conclusion</h3> Early intervention and management of endometriosis and pelvic pain in the adolescent population can decrease delay in diagnosis, long-term suffering, and potentially a reduction in disease progression. Diagnostic laparoscopy with biopsy and surgical therapy should not be delayed in the adolescent patients who are refractory to medical therapy; it still remains the gold standard in the diagnosis of endometriosis.