{"paper_id":"804ed7c9-9e00-4872-8835-4de54a0ad225","body_text":"Abstract\nEndometriosis in adolescents, like in adults, is considered a chronic disease without a cure. It is also considered a progressive disease which can continue to advance if left untreated (Doyle et al., J Pediatr Adolesc Gynecol 22:257–263, 2009). Medical management of endometriosis has evolved throughout the ages from questionable oral concoctions to our modern treatment options. The goals of contemporary treatment include adequate pain control and hormonal suppression (The American College of Obstetricians and Gynecologists, Obstet Gynecol 132:e249–e258, 2018). Diagnostic laparoscopy is commonly utilized in the evaluation of suspected endometriosis. At the time of initial laparoscopy, conservative surgical therapy with resection, coagulation, or ablation of endometriotic lesions is recommended (Laufer et al., J Pediatr Adolesc Gynecol 16:S3–11, 2003). Following surgery, hormonal suppressive therapy is the first-line therapy for adolescents which can be initiated post-operatively or continued if previously started in cases of suspected endometriosis (The American College of Obstetricians and Gynecologists, Obstet Gynecol 132:e249–e258, 2018). There is no single best therapy for the medical management of endometriosis, and multiple treatment modalities are usually necessary.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nAbbreviations\n- ACOG:\n-\nAmerican College of Obstetrician and Gynecologists\n- AI:\n-\nAromatase inhibitors\n- BMD:\n-\nBone mineral density\n- CEE:\n-\nConjugated equine estrogen\n- CHT:\n-\nCombination hormonal therapy\n- COC:\n-\nCombined oral contraceptive\n- DEXA:\n-\nDual-energy X-ray absorptiometry\n- DMPA:\n-\nDepot medroxyprogesterone acetate\n- ENG:\n-\nEtonogestrel\n- FDA:\n-\nFood and Drug Administration\n- FSH:\n-\nFollicle-stimulating hormone\n- GnRH:\n-\nGonadotropin-releasing hormone\n- LH:\n-\nLuteinizing hormone\n- LNG-IUD:\n-\nLevonorgestrel-releasing IUD\n- MPA:\n-\nMedroxyprogesterone acetate\n- NA:\n-\nNorethindrone acetate\n- NSAIDs:\n-\nNon-steroidal anti-inflammatory drugs\n- SERM:\n-\nSelective estrogen receptor modulators\n- SPRM:\n-\nSelective progesterone receptor modulators\n- TENS:\n-\nTranscutaneous electrical stimulation\n- WHO:\n-\nWorld Health Organization\nReferences\nDoyle J, Missmer S, Laufer M. The effect of combined surgical-medical intervention on the progression of endometriosis in an adolescent and young adult population. J Pediatr Adolesc Gynecol. 2009;22:257–63.\nThe American College of Obstetricians and Gynecologists. Committee Opinion No. 760: Dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol. 2018;132:e249–58.\nLaufer M, Sanfilippo J, Rose G. Adolescent endometriosis: diagnosis and treatment approaches. J Pediatr Adolesc Gynecol. 2003;16:S3–11.\nNezhat C, Nezhat F, Nezhat CH. Endometriosis: ancient disease, ancient treatments. Fert Steril. 2012;98(6s):1s–62s.\nMama S. Advances in the management of endometriosis in the adolescent. Curr Opin Obstet Gynecol. 2018;39:326–30.\nSoares S, Martinez-Varea A, Hidalgo-Mora J, Pellicer A. Pharmacologic therapies in endometriosis: a systematic review. Fertil Steril. 2012;98:529–55.\nDowlut-McElroy T, Strickland J. Endometriosis in adolescents. Curr Opin Obstet Gynecol. 2017;29:306–9.\nUnger C, Laufer M. Progression of endometriosis in non-medically managed adolescents: a case series. J Pediatr Adolesc Gynecol. 2011;24:e21–3.\nAudebert A, Lecointre L, Afors K, Koch A, Wattiez A, Akladios C. Adolescent endometriosis: report of a series of 55 cases with a focus on clinical presentation and long-term issues. J Minim Invasive Gynecol. 2015;22:834–40.\nThe American College of Obstetricians and Gynecologists. Practice Bulletin No. 114: Management of endometriosis. Obstet Gynecol. 2010;116:223–36.\nDavis A, Westhoff C, O’Connell K, Gallagher N. Oral contraceptives for dysmenorrhea in adolescent girls: a randomized controlled trial. Obstet Gynecol. 2005;106:97–104.\nKistner R. The treatment of endometriosis by inducing pseudopregnancy with ovarian hormones. A report of fifty-eight cases. Fertil Steril. 1959;10:539–56.\nVercellini P, Frontino G, De Giorgi O, Pietropaolo G, Pasin R, Crosignani P. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil Steril. 2003;80:560–3.\nVercellini P, Barbara G, Somigliana E, Bianchi S, Abbiati A, Fedele L. Comparison of contraceptive ring and patch for the treatment of symptomatic endometriosis. Fertil Steril. 2010;93:2150–61.\nQuaas A, Weedin E, Hansen K. On-label and off-label drug use in the treatment of endometriosis. Fertil Steril. 2015;103:612–25.\nGrimstad F, Dowlut-McElroy T. Effectiveness of norethindrone-acetate in the treatment of surgically diagnosed endometriosis in adolescents. J Pediatr Adolesc Gynecol. 2018;31:192–3.\nKaser D, Missmer S, Berry K, Laufer M. Use of norethindrone acetate alone for postoperative suppression of endometriosis symptoms. J Pediatr Adolesc Gynecol. 2012;25:105–8.\nBuggio L, Somigliana E, Barbara G, Frattaruolo M, Vercellini P. Oral and depot progestin therapy for endometriosis: towards a personalized medicine. Expert Opin Pharmacother. 2017;18:1569–81.\nChu M, Zhang X, Gentzschein E, Stanczyk F, Lobo R. Formation of ethinyl estradiol in women during treatment with norethindrone acetate. J Clin Endocrinol Metab. 2007;92:2205–7.\nLuciano A, Turksoy R, Carleo J. Evaluation of oral medroxyprogesterone acetate in the treatment of endometriosis. Obstet Gynecol. 1988;72:323–7.\nCrosignani P, Luciano A, Ray A, Bergqvist A. Subcutaneous depot medroxyprogesterone acetate versus leuprolide acetate in the treatment of endometriosis-associated pain. Hum Reprod. 2006;21:248–56.\nSchlaff W, Carson S, Luciano A, Ross D, Bergqvist A. Subcutaneous injection of depot medroxyprogesterone acetate compared with leuprolide acetate in the treatment of endometriosis-associated pain. Fertil Steril. 2006;85:314–25.\nThe American College of Obstetricians and Gynecologists. Committee Opinion No. 602: Depot medroxyprogesterone acetate and bone effects. Obstet Gynecol. 2014;123:1398–402.\nViganò P, Somigliana E, Vercellini P. Levonorgestrel-releasing intrauterine system for the treatment of endometriosis: biological and clinical evidence. Womens Health (Lond). 2007;3:207–14.\nBayoglu Tekin Y, Dilbaz B, Altinbas S, Dilbaz S. Postoperative medical treatment of chronic pelvic pain related to severe endometriosis: levonorgestrel-releasing intrauterine system versus gonadotropin-releasing hormone analogue. Fertil Steril. 2011;95:492–6.\nWong A, Tang L, Chin R. Levonorgestrel-releasing intrauterine system (Mirena) and Depot medroxyprogesterone acetate (Depo-Provera) as long-term maintenance therapy for patients with moderate and severe endometriosis: a randomised controlled trial. Aust N Z J Obstet Gynaecol. 2010;50:273–9.\nVercellini P, Frontino G, De Giorgi O, Aimi G, Zaina B, Crosignani P. Comparison of a levonorgestrel-releasing intrauterine device versus expectant management after conservative surgery for symptomatic endometriosis: a pilot study. Fertil Steril. 2003;80:305–9.\nYoost J, Loveless M, Hertweck P. Long term follow up of adolescents treated for endometriosis. J Pediatr Adolesc Gynecol. 2014;27:e41.\nBryce E, Young-Lin N, Hillard P. Use of LNG-IUS in adolescents with dysmenorrhea or chronic pelvic pain. J Pediatr Adolesc Gynecol. 2018;31:173–4.\nBayer L, Hillard P. Use of levonorgestrel intrauterine system for medical indications in adolescents. J Adolesc Health. 2013;52:S54–8.\nMcNicholas C, Maddipati R, Zhao Q, Swor E, Peipert J. Use of the etonogestrel implant and levonorgestrel intrauterine device beyond the U.S. Food and Drug Administration-approved duration. Obstet Gynecol. 2015;125:599–604.\nBrown J, Crawford T, Datta S, Prentice A. Oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2018;5(5):CD001019.\nBrown J, Pan A, Hart R. Gonadotropin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. 2010;(12):CD008475.\nJensen J, Schlaff W, Gordon K. Use of combined hormonal contraceptives for the treatment of endometriosis-related pain: a systematic review of the evidence. Fertil Steril. 2018;110:137–52.\nDlugi A, Miller J, Knittle J. Lupron depot (leuprolide acetate for depot suspension) in the treatment of endometriosis: a randomized placebo-controlled, double-blind study. Lupron Study Group. Fertil Steril. 1990;54:419–27.\nGolden N, Abrams S, Committee on Nutrition. Optimizing bone health in children and adolescents. Pediatrics. 2014;134:e1229–43.\nBarbieri R. Hormone treatment of endometriosis: the estrogen threshold hypothesis. Am J Obstet Gynecol. 1992;166:740–5.\nHornstein M, Surrey E, Weisberg G, Casino L. Leuprolide acetate depot and hormonal add-back in endometriosis: a 12-month study. Lupron Add-Back Study Group. Obstet Gynecol. 1998;91:16–24.\nDiVasta A, Feldman H, Sadler Gallagher J, Stokes N, Laufer M, Hornstein M, et al. Hormonal add-back therapy for females treated with gonadotropin-releasing hormone agonist for endometriosis: a randomized controlled trial. Obstet Gynecol. 2015;126:617–27.\nDiVasta A, Laufer M, Gordon C. Bone density in adolescents treated with a GnRH agonist and add-back therapy for endometriosis. J Pediatr Adolesc Gynecol. 2007;20:293–7.\nSadler Gallagher J, Feldman H, Stokes N, Laufer M, Hornstein M, Gordon C, et al. The effects of gonadotropin-releasing hormone agonist combined with add-back therapy on quality of life for adolescents with endometriosis: a randomized controlled trial. J Pediatr Adolesc Gynecol. 2017;30:215–22.\nBedaiwy M, Casper R. Treatment with leuprolide acetate and hormonal add-back for up to 10 years in stage IV endometriosis patients with chronic pelvic pain. Fertil Steril. 2006;86:220–2.\nSelak V, Farquhar C, Prentice A, Singla A. Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev. 2007;(4):CD000068.\nKöhler G, Faustmann T, Gerlinger C, Mueck A. A dose-ranging study to determine the efficacy and safety of 1, 2, and 4 mg of dienogest daily for endometriosis. Int J Gynaecol Obstet. 2010;108:21–5.\nWhalen K, Rose R. Estradiol valerate/dienogest: a novel oral contraceptive. Ann Pharmacother. 2011;45:1256–61.\nStrowitzki T, Marr J, Gerlinger C, Faustmann T, Seitz C. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24 week, randomized, multicenter, open-label trial. Hum Reprod. 2010;25:633–41.\nStrowitzki T, Marr J, Gerlinger C, Faustmann T, Seitz C. Detailed analysis of a randomized, multicenter, comparative trial of dienogest versus leuprolide acetate in endometriosis. Int J Gynaecol Obstet. 2012;117:228–33.\nEbert A, Dong L, Merz M, Kirsch B, Francuski M, Böttcher B, et al. Dienogest 2 mg daily in the treatment of adolescents with clinically suspected endometriosis: the VISanne study to assess safety in ADOlescents. J Pediatr Adolesc Gynecol. 2017;30:550–67.\nDiamond M, Dmowski W, Koltun W, O’Brien C, Jiang P, Burke J, et al. Elagolix treatment for endometriosis-related pain: results from a phase 2 randomized, double-blind, placebo-controlled study. Reprod Sci. 2014;21:363–71.\nKauppila A, Rönnberg L. Naproxen sodium in dysmenorrhea secondary to endometriosis. Obstet Gynecol. 1985;65:379–83.\nAllen C, Hopewell S, Prentice A. Non-steroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2005;(4):CD004753.\nMarjoribanks J, Ayeleke R, Farquhar C, Proctor M. Nonsteroidal anti-inflammatory drugs for dysmenorrhea. Cochrane Database Syst Rev. 2015;(7):CD001751.\nPeters A, van Dorst E, Jellis B, van Zuuren B, Hermans J, Trimbos J. A randomized clinical trial to compare two different approaches in women with chronic pelvic pain. Obstet Gynecol. 1991;77:740–4.\nGallagher J, DiVasta A, Vitonis A, Sarda V, Laufer M, Missmer S. The impact of endometriosis on quality of life in adolescents. J Adolesc Health. 2018;63:766–72.\nKeller P. Endometriosis: beyond the basics pain management in endometriosis [PowerPoint slides]. 2016. Retrieved from https://hmc.pennstatehealth.org/documents/11396232/11444874/Pain+Management+in+Endometriosis/8c8cdcd4-af1e-487b-833b-7c74595f1991.\nMayo Clinic. Prescription drug abuse. 2019. Retrieved from https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/symptoms-causes/syc-20376813. Accessed 13 Feb 2019.\nGreco C. Management of adolescent chronic pelvic pain from endometriosis: a pain center perspective. J Pediatr Adolesc Gynecol. 2003;16:S17–9.\nSchroeder B, Sanfilippo J, Hertweck S. Musculoskeletal pelvic pain in a pediatric and adolescent gynecology practice. J Pediatr Adolesc Gynecol. 2000;13:90.\nWayne P, Kerr C, Schnyer R, Legedza A, Savetsky-German J, Shields M, et al. Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial. J Pediatr Adolesc Gynecol. 2008;21:247–57.\nThe American College of Obstetricians and Gynecologists. Committee Opinion No. 738: Aromatase inhibitors in gynecologic practice. Obstet Gynecol. 2018;131:e194–9.\nEl-Gizawy Z, Tzakas E, O’Brien P. Systematic review of the effects of aromatase inhibitors on pain associated with endometriosis. BJOG. 2008;115:1721–2.\nAttar E, Bulun S. Aromatase inhibitors: the next generation of therapeutics for endometriosis? Fertil Steril. 2006;85:1307–18.\nRemorgida V, Abbamonte L, Ragni N, Fulcheri E, Ferrero S. Letrozole and desogestrel-only contraceptive pill for the treatment of stage IV endometriosis. Aust N Z J Obstet Gynaecol. 2007;47:222–5.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2020 Springer Nature Switzerland AG\nAbout this chapter\nCite this chapter\nPerez-Milicua, G. (2020). Medical Management of Endometriosis in Adolescents. In: Nezhat, C.H. (eds) Endometriosis in Adolescents. Springer, Cham. https://doi.org/10.1007/978-3-030-52984-0_39\nDownload citation\nDOI: https://doi.org/10.1007/978-3-030-52984-0_39\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-030-52983-3\nOnline ISBN: 978-3-030-52984-0\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}