Fig. 7.1
Algorhythm for diagnosis and treatment of endometriosis. Abbreviations: NSAIDs nonsteroidal anti-inflammatory drugs, CHT combination hormone therapy (oral contraceptive pills, estrogen/progestin patch, estrogen/progestin vaginal ring, norethindrone acetate, medroxyprogesterone acetate), GnRH gonadotropin-releasing hormone. *Add-back indicates use of estrogen and progestin or norethindrone acetate alone. ACOG Committee Opinion: No 310. Endometriosis in adolescents. Obstet Gynecol 2005;105:921 modified from Bandera CA, Brown LR, Laufer MR. Adolescents and endometriosis. Clin Consult Obstet Gyncol 1995;7:206; with permission
In summary, endometriosis is a common cause of dysmenorrhea in adolescents and should be on the differential for any patient with chronic pelvic pain . Suspicion should be further heightened in those with pain unresponsive to conservative management with NSAIDs and oral contraceptive pills, which is the first-line therapy for this disease. Surgical diagnosis and treatment should be strongly considered in this population. More data is needed to better elucidate the cause of endometriosis and determine the best options for long-term, postsurgical symptom control and treatment.
Clinical Pearls and Pitfalls
Acute pelvic pain has a different differential diagnosis than chronic pelvic pain and should elicit a workup to rule out potentially life-threatening or life-altering etiologies.
Physicians should strongly consider diagnostic laparoscopy to rule out endometriosis in young women with dysmenorrhea refractory to COCPs.
Endometriosis in adolescents does not have the typical powder burn characteristics seen in adults but are more commonly clear vesicular and red-flame-like lesions.
Goals of surgery for endometriosis in adolescents should be diagnosis and destruction/removal of visible lesions with care to avoid any procedures that might harm future fertility.
A multidisciplinary approach to treatment of adolescents with endometriosis may be needed with involvement of psychiatry, pain specialists, and complementary medicine to be considered.
More research is needed to elucidate standard of care for postsurgical treatment of endometriosis, but most commonly patients are put on hormonal suppression of some type.
References
1.
Emans SJ, Laufer MR. Emans, Laufer, Goldstein’s pediatric & adolescent gynecology. Chapter 13, Gynecologic pain: dysmenorrhea, acute and chronic pelvic pain, endometriosis, and premenstrual syndrome. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012. p. 238–69.
2.
Laufer MR. Current approaches to optimizing the treatment of endometriosis in adolescents. Gynecol Obstet. Invest. 2008;66:19–27.CrossrefPubMed
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