Endometriosis in Adolescence: Challenges and Opportunities for Managing Future Infertility

Abstract

Endometriosis is defined as the presence of endometrial stroma and glands outside the normal uterus. The prevalence of endometriosis in adolescents undergoing laparoscopy for chronic pelvic pain is reported to be between 19% and 73%. Interestingly, endometriosis has also been identified in premenarcheal girls with some breast development. Several factors have been incriminated for endometriosis, while no single theory can explain the variety of symptoms. Genetic factors seem to play a role, while lifestyle characteristics and environmental factors are likely related to the development of the disease. The main symptoms during diagnosis of endometriosis in adolescence, is chronic pelvic pain (27%-96%) and dysmenorrhea (18%-100%). Medical history and clinical examination are of great importance, while imaging exams are very helpful during evaluation of these girls, while endometriosis can only be diagnosed by visual inspection during laparoscopy, ideally confirmed by histology. Treatment options include not only medical regimens, with Non-Steroidal-Anti-Inflammatory Drugs and Combined Oral Contraceptives been the most common used, and other medications such as Danazol, Progestins, GnRH agonists with Add-Back therapy and cyproterone acetate, but also surgical treatment. Surgical management alone or in combination with postoperative hormonal suppression seems to improve future fertility options of adolescents with endometriosis.