ESPE Abstracts (2015) 84 WG5.4

Diagnosis and Management of Endometriosis in Adolescence

Patrick Puttemans

Unit of Reproductive Medicine and Surgical Day Care Unit, Regional Hospital Heilig Hart, Leuven, Belgium

The presence of endometriosis, from minimal/mild disease up to the rASRM classification for endometriosis stages III and IV, has been described repeatedly in adolescent women. The complaints are common and elicit compassion, but rarely stimulate a thorough research of the cause. The clinical reality is that common complaints of dysmenorrhea or acyclic pelvic pain – even before the onset of menstruation – may hide a disease the severity of which is not reflected by the degree of discomfort and that already may have reached a stage in which the future reproductive life of an otherwise healthy teenager is severely and irreversibly compromised. Especially in these young women, endometriosis remains a disease with an unacceptable delay of the diagnosis, mainly because non-invasive tools are unavailable for the reliable ‘early-stage’ diagnosis of the condition. And that delay is one if not the most important reason for its progression. The true incidence of adolescent endometriosis is indeed severely biased by the necessity of a laparoscopy for the diagnosis. This presentation intends to elucidate the clinical entity of adolescent endometriosis, including its pathogenesis and evolution. It also attempts to accelerate and improve the diagnosis and the treatment of this often neglected condition. Compared to adult endometriosis, adolescent endometriosis typically presents with a high percentage of subtle, yet active implants on the peritoneal surface and inside small endometriomas of the ovaries whereas the deeply infiltrating (adenomyotic) type, like in rectovaginal endometriosis, and the considerably large and/or bilateral endometriomas are rare. A first-line diagnostic approach includes the use of a high-resolution ultrasound and a CA-125 assay during menstruation. Non-steroidal anti-inflammatory drugs (NSAIDs) and/or a trial treatment with a monophasic contraceptive pill are the first-line therapeutic possibilities, provided there are no contraindications. Although the gold standard for the diagnosis is a standard transumbilical laparoscopy, transvaginal hydrolaparoscopy definitely offers a number of advantages in the sexually active adolescent, both diagnostic and therapeutic.

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