Endométriose chez l’adolescente

Abstract

Endometriosis can affect adolescent girls. During the late years of teenage, its incidence is close to those of adult women. Physiopathological mechanisms allow, schematically, to identify three forms of this disease with very different practical issues: endometriosis due to a congenital obstructive abnormality of the genital tract, occurs early in the adolescence. Usually, lesions disappear spontaneously after the surgical treatment of the obstructive abnormality. Obstructive malformations need to be routinely screened and ideally treated preventively; the most frequent presentation occurs during the late years of adolescence, after usually 4 or 5 years of menstruations, often painful and excessive by their duration or frequency. Cyclic or acyclic pelvic pain, unresponsive to usual treatments (antalgic or anti-inflammatory agents or oral contraceptives (OC), is the main raison leading to its diagnosis, by the clinical examination and mostly laparoscopy. The lesions are usually subtle and less severe. They are eradicated at the time of laparoscopy and a continuous treatment with gestagens or OC is recommended, in order to postpone recurrences and reduce the risk of worsening; the third form, more theoretical at the moment because of the lack of validated marker, is endometriosis occurring on a predisposed host (familial history, genetic abnormality…), with severe and quickly recurrent lesions. The management of this form is similar to the preceding one, with in some cases, after 16 years of age and for a short period of time, the need to use Gn–Rh analogues arises. These forms are the most difficult to manage on long-term basis, and their prognosis is the less favourable.