{"paper_id":"dabcdff8-c67e-43b5-b989-f1f5aa0523c6","body_text":"Abstract\nPurpose of Review\nAdolescent endometriosis and chronic pelvic pain frequently overlap but represent distinct clinical entities requiring thoughtful diagnostic and management approach. This review summarizes recent advances in understanding adolescent endometriosis and its role in chronic pelvic pain, a condition frequently underrecognized and associated with significant diagnostic delay. We discuss emerging evidence regarding symptom patterns, mechanisms of pain, and treatment approaches.\nRecent Findings\nIncreasing evidence supports a shift towards a noninvasive clinical diagnosis of endometriosis in adolescents rather than delaying treatment for surgical confirmation. Specialized imaging and biomarkers show promise for identifying later stage disease; they currently lack the sensitivity to definitively rule out endometriosis and are not yet validated in this population. Emerging data highlights the role of central sensitization and biopsychosocial factors in pain persistence, explaining why symptoms of endometriosis and chronic pelvic pain coexist and warrant multimodal management.\nSummary\nChronic pelvic pain and endometriosis require comprehensive evaluation and management approaches that combine hormonal therapy, specialized surgery, and adjunctive treatments like pelvic floor physical therapy. Early intervention optimizes care and may mitigate long-term consequences on reproductive health and psychological well-being.\nSimilar content being viewed by others\nData Availability\nNo datasets were generated or analysed during the current study.\nReferences\nWhitaker LHR, Reid J, Choa A, McFee S, Seretny M, Wilson J, et al. An Exploratory Study into Objective and Reported Characteristics of Neuropathic Pain in Women with Chronic Pelvic Pain. PLoS ONE. 2016;11(4):e0151950.\nSaridoğan E. Endometriosis in Teenagers. Womens Health (Lond Engl). 2015;11(5):705–9.\nLazzeri L, Andersson KL, Angioni S, Arena A, Arena S, Bartiromo L, et al. How to Manage Endometriosis in Adolescence: The Endometriosis Treatment Italian Club Approach. J Minim Invasive Gynecol. 2023;30(8):616–26.\nMartire FG, Piccione E, Exacoustos C, Zupi E. Endometriosis and Adolescence: The Impact of Dysmenorrhea. J Clin Med. 2023;12(17):5624.\nBergus KC, Rachwal B, Asti L, Breech LL, Gong YY, Hertweck SP, et al. Characteristics and Preoperative Management of Adolescent Patients With Pathology-Confirmed Endometriosis: A Multi-Institutional Study. Obstet Gynecol Surv. 2026;81(1):19.\nAgarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(4):354.e1-354.e12.\nRoyal College of Obstetricians and Gynecologists. The initial management of chronic pelvic pain, Green-top guideline No.41 [Internet]. 2012 [cited 2026 Feb 22]. Available from: https://www.rcog.org.uk/media/muab2gj2/gtg_41.pdf\nSachedin A, Todd N. Dysmenorrhea, endometriosis and chronic pelvic pain in adolescents. J Clin Res Pediatr Endocrinol [Internet]. 2020 Jun 2 [cited 2026 Feb 22]; Available from: https://jcrpe.org/articles/dysmenorrhea-endometriosis-and-chronic-pelvic-pain-in-adolescents/jcrpe.galenos.2019.2019.S0217\nZondervan KT, Becker CM, Missmer SA, Endometriosis. N Engl J Med. 2020;382(13):1244–56.\nTaylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839–52.\nAs-Sanie S, Mackenzie SC, Morrison L, Schrepf A, Zondervan KT, Horne AW, et al. Endometriosis: Rev JAMA. 2025;334(1):64–78.\nSkalecki DSL, Kimble PRM, Ballard HPEL, Baartz DDL. Presence and laterality of endometriosis in adolescent patients with obstructed müllerian duct anomalies, a twenty-three year retrospective cohort analysis between 2002 – 2025 at an Australian Quaternary paediatric and adolescent gynaecology service. J Pediatr Adolesc Gynecol [Internet]. 20263 [cited 2026 Feb 15];0(0). Available from: https://www.jpagonline.org/article/S1083-3188(26)00002-1/fulltext\nJerman LF, Hey-Cunningham AJ. The role of the lymphatic system in endometriosis: a comprehensive review of the literature. Biol Reprod [Internet]. 2015 [cited 2026 Feb 15];92(3). Available from: https://doi.org/10.1095/biolreprod.114.124313\nSasamoto N, Ngo L, Vitonis AF, Dillon ST, Sieberg CB, Missmer SA, et al. Plasma proteomic profiles of pain subtypes in adolescents and young adults with endometriosis. Hum Reprod. 2023;38(8):1509–19.\nDaniels JP, Khan KS. Chronic pelvic pain in women. 2010 Oct 5 [cited 2026 Feb 22]; Available from: https://www.bmj.com/content/341/bmj.c4834\nZondervan KT, Yudkin PL, Vessey MP, Dawes MG, Barlow DH, Kennedy SH. Patterns of diagnosis and referral in women consulting for chronic pelvic pain in UK primary care. BJOG: Int J Obstet Gynecol. 1999;106(11):1156–61.\nSteele LA, Mooney SS, Gilbee ES, Grover SR. When you see nothing at all: Outcomes following a negative laparoscopy. A systematic review. Aust N Z J Obstet Gynaecol. 2024;64(2):95–103.\nShim JY, Laufer MR. Adolescent Endometriosis: An Update. J Pediatr Adolesc Gynecol. 2020;33(2):112–9.\nViscardi MF, Piacenti I, Musella A, Cacciamani L, Piccioni MG, Manganaro L, et al. Endometriosis in Adolescents: A Closer Look at the Pain Characteristics and Atypical Symptoms: A Prospective Cohort Study. J Clin Med. 2025;14(4):1392.\nBenagiano G, Guo SW, Puttemans P, Gordts S, Brosens I. Progress in the diagnosis and management of adolescent endometriosis: an opinion. Reprod Biomed Online. 2018;36(1):102–14.\nIacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21(6):762–78.\nGupta J, Cardoso LF, Harris CS, Dance AD, Seckin T, Baker N et al. How do adolescent girls and boys perceive symptoms suggestive of endometriosis among their peers? Findings from focus group discussions in New York City. 2018 Jun 1 [cited 2026 Feb 22]; Available from: https://bmjopen.bmj.com/content/8/6/e020657\nSarıdoğan E. Adolescent endometriosis. Eur J Obstet Gynecol Reproductive Biology. 2017;209:46–9.\nRasp E, Rönö K, But A, Gissler M, Härkki P, Heikinheimo O, et al. Burden of somatic morbidity associated with a surgically verified diagnosis of endometriosis at a young age: a register-based follow-up cohort study in Finland. Hum Reprod. 2025;40(4):623–32.\nGallagher JS, DiVasta AD, Vitonis AF, Sarda V, Laufer MR, Missmer SA. The Impact of Endometriosis on Quality of Life in Adolescents. J Adolesc Health. 2018;63(6):766–72.\nOliveira IJ, Pinto PV, Bernardes J. Noninvasive Diagnosis of Endometriosis in Adolescents and Young Female Adults: A Systematic Review. J Pediatr Adolesc Gynecol. 2025;38(2):124–38.\nMartire FG, Russo C, Selntigia A, Nocita E, Soreca G, Lazzeri L, et al. Early noninvasive diagnosis of endometriosis: dysmenorrhea and specific ultrasound findings are important indicators in young women. Fertil Steril. 2023;119(3):455–64.\nAvery JC, Knox S, Deslandes A, Leonardi M, Lo G, Wang H, et al. Noninvasive diagnostic imaging for endometriosis part 2: a systematic review of recent developments in magnetic resonance imaging, nuclear medicine and computed tomography. Fertil Steril. 2024;121(2):189–211.\nAs-Sanie S, Ross WT, Till SR. Evaluation and Treatment of Chronic Pelvic Pain. Obstet Gynecol. 2026;147(1):21.\nLamvu G, Carrillo J, Ouyang C, Rapkin A. Chronic Pelvic Pain in Women: A Review. JAMA. 2021;325(23):2381–91.\nGibbons T, Rahmioglu N, Zondervan KT, Becker CM. Crimson clues: advancing endometriosis detection and management with novel blood biomarkers. Fertil Steril. 2024;121(2):145–63.\nHerranz-Blanco B, Daoud E, Viganò P, García-Velasco JA, Colli E. Development and Validation of an Endometriosis Diagnostic Method Based on Serum Biomarkers and Clinical Variables. Biomolecules. 2023;13(7):1052.\nGuo C, Zhang C. Platelet-to-Lymphocyte Ratio and CA125 Level as a Combined Biomarker for Diagnosing Endometriosis and Predicting Pelvic Adhesion Severity. Front Oncol. 2022;12:896152.\nShokrnejad-namin T, Farzizadeh N, Najmi Z, Amoozgar M, Hariri A, Amini E et al. Evaluating the diagnostic potential of CA-125 and miRNA levels in endometriosis: A narrative review. Int J Gynecol Obstetr [Internet]. [cited 2026 Feb 22];n/a(n/a). Available from: https://onlinelibrary.wiley.com/doi/abs/https://doi.org/10.1002/ijgo.70554\nEvans JR, Bergus K, Asti L, Breech LL, Cen R, Gong YY, et al. Intraoperative Care and Complications of Symptomatic Adolescent and Young Adult Patients Undergoing Laparoscopy to Diagnose and/or to Treat Endometrioses: A Multi-Institutional Review. J Pediatr Adolesc Gynecol. 2026;39(1):94–100.\nShim JY, Laufer MR, King CR, Lee TTM, Einarsson JI, Tyson N. Evaluation and Management of Endometriosis in the Adolescent. Obstet Gynecol. 2024;143(1):44.\nSong AH, Advincula AP. Adolescent Chronic Pelvic Pain. J Pediatr Adolesc Gynecol. 2005;18(6):371–7.\nTyson N, Shim J, Lee T, King CR, Einarsson J, Hornstein MD, et al. Surgical Considerations in the Management of Adolescent Endometriosis—An Expert Commentary. J Minim Invasive Gynecol. 2024;31(5):378–86.\nDovey S, Sanfilippo J. Endometriosis and the Adolescent. Clin Obstet Gynecol. 2010;53(2):420.\nAmerican Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817–21.\nAbrao MS, Andres MP, Miller CE, Gingold JA, Rius M, Neto JS, et al. AAGL 2021 Endometriosis Classification: An Anatomy-based Surgical Complexity Score. J Minim Invasive Gynecol. 2021;28(11):1941–e19501.\nKhashchenko EP, Uvarova EV, Fatkhudinov TK, Chuprynin VD, Asaturova AV, Kulabukhova EA et al. Endometriosis in adolescents: diagnostics, clinical and laparoscopic features. J Clin Med [Internet]. 2023 [cited 2026 Feb 23];12(4). Available from: https://www.mdpi.com/2077-0383/12/4/1678\nFernando S, Soh PQ, Cooper M, Evans S, Reid G, Tsaltas J, et al. Reliability of Visual Diagnosis of Endometriosis. J Minim Invasive Gynecol. 2013;20(6):783–9.\nHirsch M, Dhillon-Smith R, Cutner AS, Yap M, Creighton SM. The Prevalence of Endometriosis in Adolescents with Pelvic Pain: A Systematic Review. J Pediatr Adolesc Gynecol. 2020;33(6):623–30.\nJanssen EB, Rijkers ACM, Hoppenbrouwers K, Meuleman C, D’Hooghe TM. Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: a systematic review. Hum Reprod Update. 2013;19(5):570–82.\nHebbar S, Chawla C. Role of laparoscopy in evaluation of chronic pelvic pain. J Minim Access Surg. 2005;1(3):116.\nChapron C, Marcellin L, Maitrot-Mantelet L, Bourdon M, Maignien C, Parpex G, et al. Questionnaire-based screening of adolescents and young adult women can identify markers associated with endometriosis. Hum Reprod. 2024;39(8):1664–72.\nLi HJ, Esencan E, Song Y, Taylor HS, Cho Y, Vash-Margita A. Medical Management of Endometriosis in Adolescent and Young Adult Women: A Review of 91 Cases of Biopsy-Confirmed Endometriosis. Journal of Obstetrics and Gynaecology Canada [Internet]. 2024 Jul 1 [cited 2026 Feb 16];46(7). Available from: https://www.jogc.com/article/S1701-2163(24)00385-2/fulltext\nAlonso A, Gunther K, Maheux-Lacroix S, Abbott J. Medical management of endometriosis. Curr Opin Obstet Gynecol. 2024;36(5):353.\nACOG Committee Opinion No. 760: Dysmenorrhea and Endometriosis in the Adolescent. Obstetr Gynecol. 2018;132(6):e249.\nSong XC, Yu X, Luo M, Yu Q, Zhu L. Clinical Characteristics and Postoperative Symptoms of 85 Adolescents with Endometriosis. J Pediatr Adolesc Gynecol. 2020;33(5):519–23.\nShim JY, Scatoni A, Laufer MR, Boskey ER. Surgical management of endometriosis in adolescents versus adults: a National Surgical Quality Improvement Program study. Fertil Steril. 2025;124(6):1293–302.\nBurks C, Lee M, DeSarno M, Findley J, Flyckt R. Excision versus Ablation for Management of Minimal to Mild Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2021;28(3):587–97.\nLaufer MR, Einarsson JI. Surgical Management of Superficial Peritoneal Adolescent Endometriosis. J Pediatr Adolesc Gynecol. 2019;32(3):339–41.\nPain Management for In-Office Uterine and Cervical Procedures. ACOG Clin Consensus 9 Obstet Gynecol. 2025;146(1):161.\nSmith A, Bhullar S, Vash-Margita A. Endometriosis in adolescents: A state-of-the-art review. Best Pract Res Clin Obstet Gynecol. 2026;105:102706.\nMansfield C, Lenobel D, McCracken K, Hewitt G, Appiah LC. Impact of Pelvic Floor Physical Therapy on Function in Adolescents and Young Adults with Biopsy-Confirmed Endometriosis at a Tertiary Children’s Hospital: A Case Series. J Pediatr Adolesc Gynecol. 2022;35(6):722–7.\nChronic Pelvic Pain. ACOG Practice Bulletin, Number 218. Obstet Gynecol. 2020;135(3):e98.\nLalla AT, Onyebuchi C, Jorgensen E, Clark N. Impact of lifestyle and dietary modifications for endometriosis development and symptom management. Curr Opin Obstet Gynecol. 2024;36(4):247.\nTennfjord MK, Gabrielsen R, Tellum T. Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC Women’s Health. 2021;21(1):355.\nMartire FG, Costantini E, d’Abate C, Capria G, Piccione E, Andreoli A. Endometriosis and Nutrition: Therapeutic Perspectives. J Clin Med. 2025;14(11):3987.\nTaffs L, Waters N, Marino J, Rapsey C, Peate M, Girling JE. Supportive Care Needs of Young Adults With Endometriosis: An Open-Ended Online Survey and Exploration of Unmet Needs. Health Expect. 2024;27(5):e70045.\nCarrillo L, Seidman DS, Cittadini E, Meirow D. The role of fertility preservation in patients with endometriosis. J Assist Reprod Genet. 2016;33(3):317–23.\nSänger N, Menabrito M, Di Spiezo Sardo A, Estadella J, Verguts J. Fertility preservation counselling for women with endometriosis: a European online survey. Arch Gynecol Obstet. 2023;307(1):73–85.\nAuthor information\nAuthors and Affiliations\nContributions\nJ.S. receives royalties from UpToDate. J.B., H.M., and R.D. report no financial disclosures.\nCorresponding author\nEthics declarations\nCompeting interests\nJ.S. receives royalties from UpToDate.\nAdditional information\nPublisher’s Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nBatchelor, J.L., Mallinder, H., Deans, R. et al. Adolescent Endometriosis and Chronic Pelvic Pain. Curr Obstet Gynecol Rep 15, 9 (2026). https://doi.org/10.1007/s13669-026-00463-3\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s13669-026-00463-3","source_license":"CC0","license_restricted":false}