{"paper_id":"f1206d58-34ef-4a11-b5c9-0668495915de","body_text":"84 Acta Medica Bulgarica, 2025, 52 (4)\nREVIEW\nENDOMETRIOSIS IN ADOLESCENTS\nD. Hristova1, I. Ibryam1, S. Hitrova-Nikolova2, R. Tocev3, I. Kostov1\n1'HSDUWPHQW\u0003RI\u00032EVWHWULFV\u0003DQG\u0003*\\QHFRORJ\\\u000f\u00030HGLFDO\u00038QLYHUVLW\\\u0003±\u00036R¿D\u000f\u0003%XOJDULD \n8QLYHUVLW\\ 2EVWHWULFV DQG *\\QHFRORJ\\ +RVSLWDO ³0DLFKLQ GRP´ ± 6R¿D\u000f %XOJDULD \n2'HSDUWPHQW RI 2EVWHWULFV DQG *\\QHFRORJ\\ &OLQLF RI 1HRQDWRORJ\\\u000f 0HGLFDO 8QLYHUVLW\\ ± 6R¿D\u000f %XOJDULD \n8QLYHUVLW\\ 2EVWHWULFV DQG *\\QHFRORJ\\ +RVSLWDO ³0DLFKLQ GRP´ ± 6R¿D\u000f %XOJDULD \n3'HSDUWPHQW RI *HQHUDO DQG &OLQLFDO 3DWKRORJ\\\u000f 0HGLFDO 8QLYHUVLW\\ ± 6R¿D\u000f %XOJDULD \n8QLYHUVLW\\ 2EVWHWULFV DQG *\\QHFRORJ\\ +RVSLWDO ³0DLFKLQ GRP´ ± 6R¿D\u000f %XOJDULD\n$EVWUDFW\u0011\u0003(QGRPHWULRVLV\u0003LV\u0003DQ\u0003HVWURJHQ\u0010GHSHQGHQW\u0003FKURQLF\u0003LQÀDPPDWRU\\\u0003GLVHDVH\u0003FKDUDF-\nWHUL]HG\u0003E\\\u0003WKH\u0003SUROLIHUDWLRQ\u0003RI\u0003HQGRPHWULDO\u0003JODQGXODU\u0003WLVVXH\u0003DQG\u0003VWURPD\u0003RXWVLGH\u0003WKH\u0003XWHULQH\u0003\nFDYLW\\\u0011\u0003,W\u0003LV\u0003HVWLPDWHG\u0003WKDW\u0003\u0017\u0003WR\u0003\u0014\u001a\b\u0003RI\u0003DGROHVFHQW\u0003JLUOV\u0003KDYH\u0003WKH\u0003VDPH\u0003IRUP\u0003RI\u0003HQGRPHWULR-\nVLV\u000f\u0003DQG\u0003LW\u0003LV\u0003SDUWLFXODUO\\\u0003FRPPRQ\u0003DPRQJ\u0003WKRVH\u0003ZLWK\u0003G\\VPHQRUUKHD\u0003ZKR\u0003UHVSRQG\u0003SRRUO\\\u0003WR\u0003\nDQDOJHVLFV\u0003RU\u0003HVWURSURJHVWLQV\u0011\u0003)RU\u0003WKRVH\u0003VX௺HULQJ\u0003IURP\u0003UHFXUUHQW\u0003DQG\u0003FKURQLF\u0003SHOYLF\u0003SDLQ\u000f\u0003\nWKH\u0003SHUFHQWDJH\u0003ULVHV\u0003WR\u0003\u0015\u0018\u0010\u0016\u001b\b\u0011\u00033RVVLEOH\u0003H[SODQDWLRQV\u0003IRU\u0003WKH\u0003SDWKRJHQHVLV\u0003RI\u0003HQGRPH-\nWULRVLV\u0003DUH\u001d\u0003FRHORPLF\u0003PHWDSODVLD\u000f\u0003HPEU\\RQLF\u00030OOHULDQ\u0003UHVWV\u000f\u0003LDWURJHQLF\u0003LPSODQWDWLRQ\u000f\u0003YDV-\nFXODU\u0003DQG\u0003O\\PSKDWLF\u0003PHWDVWDVLV\u000f\u0003WKH\u0003JHQHWLF\u0003WKHRU\\\u000f\u0003DQG\u0003HQGRPHWULDO\u0003VWHP\u0012SURJHQLWRU\u0003FHOOV\u0003\nWKDW\u0003 UHSUHVHQW\u0003 GL௺HUHQW\u0003 K\\SRWKHVHV\u0003 EHVLGHV\u0003 6DPSVRQ¶V\u0003 WKHRU\\\u000f\u0003 WKH\u0003 FODVVLF\u0003 UHWURJUDGH\u0003\nPHQVWUXDWLRQ\u000f\u0003ZKLFK\u0003LV\u0003WKH\u0003PRVW\u0003ZLGHO\\\u0003DFFHSWHG\u0003WKHRU\\\u0003WR\u0003H[SODLQ\u0003WKH\u0003HFWRSLF\u0003LPSODQWD-\nWLRQ\u0003RI\u0003HQGRPHWULXP\u0011\u0003$FFRUGLQJ\u0003WR\u0003WKH\u0003(6+5(\u0003JXLGHOLQHV\u000f\u0003VXJJHVWLYH\u0003PDQLIHVWDWLRQV\u0003IRU\u0003\nHQGRPHWULRVLV\u0003 LQFOXGH\u0003 HDUO\\\u0003 PHQDUFKH\u000f\u0003 VHYHUH\u0003 G\\VPHQRUUKHD\u000f\u0003 G\\VSDUHXQLD\u000f\u0003 DEQRUPDO\u0003\nXWHULQH\u0003EOHHGLQJ\u000f\u0003PLGF\\FOH\u0003RU\u0003DF\\FOLF\u0003SDLQ\u000f\u0003UHVLVWDQFH\u0003WR\u0003HPSLULF\u0003PHGLFDO\u0003WUHDWPHQW\u000f\u0003DQG\u0003\nJDVWURLQWHVWLQDO\u0003DQG\u0003JHQLWRXULQDU\\\u0003V\\PSWRPV\u0011\u0003.QRZQ\u0003ULVN\u0003IDFWRUV\u0003IRU\u0003GHYHORSLQJ\u0003HQGRPH-\nWULRVLV\u0003LQFOXGH\u001d\u0003gHQHWLF\u0003SUHGLVSRVLWLRQ\u001e\u0003eSLJHQHWLF\u0003YDULDEOHV\u0003±\u0003SUHPDWXULW\\\u000f\u0003ERWWOH\u0003IHHGLQJ\u000f\u0003\nH[SRVXUH\u0003WR\u0003VRPH\u0003SROOXWDQWV\u0003ZLWK\u0003HVWURJHQLF\u0003DFWLYLW\\\u001e\u0003dysregulation of the immune and \nLQÀDPPDWRU\\\u0003UHVSRQVH\u000f\u0003DV\u0003ZHOO\u0003DV\u0003REVWUXFWLYH\u0003DQRPDOLHV\u0003RI\u0003WKH\u0003UHSURGXFWLYH\u0003WUDFW\u0011\u0003'LDJ-\nQRVLV\u0003LV\u0003PDGH\u0003E\\\u0003DFFXUDWH\u0003DQDPQHVLV\u0003±\u0003SHUVRQDO\u0003DQG\u0003IDPLO\\\u0003KLVWRU\\\u000f\u0003J\\QHFRORJLFDO\u0003H[DPL-\nnation and ultrasonographic evaluation (transabdominal and transvaginal ultrasound). \n0DJQHWLF\u0003UHVRQDQFH\u0003FDQ\u0003EH\u0003XVHIXO\u0003WR\u0003GHWHFW\u0003REVWUXFWLYH\u0003UHSURGXFWLYH\u0003WUDFW\u0003DQRPDOLHV\u0003DQG\u0003\nWR\u0003LGHQWLI\\\u0003DQG\u0003FKDUDFWHUL]H\u0003HQGRPHWULRWLF\u0003OHVLRQV\u0003WKDW\u0003DUH\u0003GL௻FXOW\u0003WR\u0003ORFDWH\u0003E\\\u0003XOWUDVRXQG\u0011\u0003\nA multidisciplinary diagnostic approach should be considered for a complete evalua-\nWLRQ\u0003RI\u0003WKHVH\u0003SDWLHQWV\u0011\u0003/DSDURVFRSLF\u0003HYLGHQFH\u0003VHUYHV\u0003DV\u0003WKH\u0003JROG\u0003VWDQGDUG\u0003IRU\u0003YHULI\\LQJ\u0003\nSHULWRQHDO\u0003 HQGRPHWULRVLV\u0003 DQG\u0003 GHWHUPLQLQJ\u0003 LWV\u0003 VWDJH\u000f\u0003 VSUHDG\u000f\u0003 DQG\u0003 VHYHULW\\\u0011\u0003$\u0003 GL௺HUHQWLDO\u0003\nGLDJQRVLV\u0003RI\u0003JDVWURLQWHVWLQDO\u0003SDWKRORJLHV\u000f\u00030OOHULDQ\u0003DQRPDOLHV\u000f\u0003UHFXUUHQW\u0003LQIHFWLRQV\u000f\u0003DQG\u0003\nadenomyosis must be made. The treatment of this disease includes medical and surgical \nLQWHUYHQWLRQV\u000f\u0003 DQG\u0003 D\u0003 FRPELQDWLRQ\u0003 RI\u0003 ERWK\u0011\u0003 (65+(\u0003 JXLGHOLQHV\u0003 DGYLVH\u0003 FOLQLFLDQV\u0003 WUHDWLQJ\u0003\nwomen with endometriosis to prescribe hormonal contraceptives or progestins to reduce \nendometriosis-associated pain. The use of gonadotropin hormone-releasing hormone \nDJRQLVWV\u0003LV\u0003DFFHSWDEOH\u0003LQ\u0003DGROHVFHQWV\u0003RQO\\\u0003LI\u0003WKH\u0003SDWLHQW\u0003ZLWK\u0003NQRZQ\u0003HQGRPHWULRVLV\u0003LV\u0003UH-\nfractory to other medical therapies or surgical treatments. The goals of medical therapy \nLQ\u0003WKH\u0003DGROHVFHQW\u0003SDWLHQW\u0003LQFOXGH\u0003V\\PSWRPDWLF\u0003UHOLHI\u000f\u0003VXSSUHVVLRQ\u0003RI\u0003GLVHDVH\u0003SURJUHVVLRQ\u000f\u0003\nand protection of future fertility.\n10.2478/AMB-2025-0081\n\n\n85Endometriosis in adolescents\nINTRODUCTION\n(\nQGRPHWULRVLV\u0003LV\u0003DQ\u0003HVWURJHQ\u0010GHSHQGHQW\u0003FKURQLF\u0003\nLQÀDPPDWRU\\\u0003GLVHDVH\u0003FKDUDFWHUL]HG\u0003E\\\u0003WKH\u0003SUR\u0010\nOLIHUDWLRQ\u0003 RI\u0003 HQGRPHWULDO\u0003 JODQGXODU\u0003 WLVVXH\u0003 DQG\u0003\nVWURPD\u0003RXWVLGH\u0003 WKH\u0003 XWHULQH\u0003 FDYLW\\\u0011\u0003 $FFRUGLQJ\u0003 WR\u0003 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DGROHV\u0010\nFHQFH\u0011\u00036WLOO\u000f\u0003WKH\\\u0003DUH\u0003NQRZQ\u0003WR\u0003EH\u0003XVHG\u0003LQ\u0003SDWLHQWV\u0003\nZLWK\u0003SUHFRFLRXV\u0003SXEHUW\\\u000f\u0003VKRUW\u0003VWDWXUH\u000f\u0003DQG\u0003JLUOV\u0003ZLWK\u0003\n0F&XQH\u0010$OEULJKW\u0003V\\QGURPH\u0003>\u0015\u0013\u000f\u0003\u0015\u0014@\u0011\n6XUJLFDO\u0003 WUHDWPHQW\u0003 LQ\u0003 SDWLHQWV\u0003 ZLWK\u0003 HQGRPHWULRVLV\u0003\nLQ\u0003 DGROHVFHQFH\u0003 FRPHV\u0003 LQWR\u0003 FRQVLGHUDWLRQ\u0003 LQ\u0003 FDV\u0010\nHV\u0003 ZLWK\u0003 LQFUHDVLQJ\u0003 VL]H\u0003 RI\u0003 RYDULDQ\u0003 HQGRPHWULRVLV\u0003\nRU\u0003 SHUVLVWHQFH\u0003 RI\u0003 WKH\u0003 SDLQ\u0003 V\\QGURPH\u0003 GHVSLWH\u0003 KRU\u0010\nPRQDO\u0003 WKHUDS\\\u000f\u0003 DV\u0003 ZHOO\u0003 DV\u0003 LQ\u0003 FDVHV\u0003 ZKHQ\u0003 RYDULDQ\u0003\nQHRSODVLD\u0003 FDQQRW\u0003 EH\u0003 H[FOXGHG\u0003 E\\\u0003 LPDJLQJ\u0003 PHWK\u0010\nRGV\u0003 RI\u0003 GLDJQRVLV\u0011\u0003 7KH\u0003 JRDO\u0003 RI\u0003 VXUJLFDO\u0003 WUHDWPHQW\u0003\nVKRXOG\u0003EH\u0003WKH\u0003FRPSOHWH\u0003UHPRYDO\u0003RI\u0003YLVLEOH\u0003OHVLRQV\u0003\nDQG\u0003UHVWRUDWLRQ\u0003RI\u0003WKH\u0003SDWLHQW¶V\u0003QRUPDO\u0003DQDWRP\\\u0011\u0003,Q\u0003\nDGROHVFHQW\u0003 SDWLHQWV\u000f\u0003 VXUJLFDO\u0003 LQWHUYHQWLRQV\u0003 VKRXOG\u0003\nEH\u0003DV\u0003VSDULQJ\u0003DV\u0003SRVVLEOH\u0011\u00035DGLFDO\u0003H[FLVLRQ\u0003RI\u0003VX\u0010\nSHU¿FLDO\u0003HQGRPHWULRVLV\u0003LV\u0003QRW\u0003SUDFWLFHG\u0003EHFDXVH\u0003RI\u0003\nWKH\u0003ULVN\u0003RI\u0003H[WHQVLYH\u0003DGKHVLYH\u0003SRVWRSHUDWLYH\u0003FRP\u0010\nSOLFDWLRQV\u0011\u0003&RPSDUHG\u0003ZLWK\u0003SDWLHQWV\u0003RI\u0003UHSURGXFWLYH\u0003\nDJH\u000f\u0003WKRVH\u0003LQ\u0003DGROHVFHQFH\u0003KDYH\u0003EHHQ\u0003UHSRUWHG\u0003WR\u0003\nKDYH\u0003D\u0003KLJKHU\u0003UHFXUUHQFH\u0003UDWH\u0003RYHU\u0003D\u0003\u0018\u0010\\HDU\u0003SHULRG\u000f\u0003\nZLWK\u0003D\u0003\u0017\u0013\u0010\u0018\u0013\b\u0003UHFXUUHQFH\u0003UDWH\u0003LQ\u0003DGROHVFHQWV\u0003ZLWK\u0010\nRXW\u0003 VXEVHTXHQW\u0003 VXUJLFDO\u0003 WUHDWPHQW\u0003 ZLWK\u0003 KRUPRQH\u0003\nWKHUDS\\\u0003>\u0018@\u0011\nCONCLUSION\n(QGRPHWULRVLV\u0003LV\u0003DQ\u0003HVWURJHQ\u0010GHSHQGHQW\u0003FKURQLF\u0003LQ\u0010\nÀDPPDWRU\\\u0003 GLVHDVH\u0003 ZLWK\u0003 D\u0003 SURJUHVVLYH\u0003 FRXUVH\u0003 WKDW\u0003\nDႇHFWV\u0003 DOO\u0003 DVSHFWV\u0003 RI\u0003 D\u0003 JLUO¶V\u0003 OLIH\u0011\u0003 7KH\u0003 WKHUDSHXWLF\u0003\nDSSURDFK\u0003 WR\u0003 SDWLHQWV\u0003 ZLWK\u0003 DGROHVFHQW\u0003 HQGRPHWULRVLV\u0003\nVKRXOG\u0003EH\u0003LQGLYLGXDOL]HG\u000f\u0003DQG\u0003FDVHV\u0003VKRXOG\u0003EH\u0003HYDOX\u0010\nDWHG\u0003E\\\u0003D\u0003PXOWLGLVFLSOLQDU\\\u0003WHDP\u0011\u00037KH\u0003DLP\u0003LV\u0003WR\u0003VKRUW\u0010\nen the time from symptom onset to diagnosis and \nWKH\u0003LQLWLDWLRQ\u0003RI\u0003WLPHO\\\u0003WUHDWPHQW\u0011\u00037KH\u0003JRDOV\u0003RI\u0003PHGL\u0010\nFDO\u0003 WKHUDS\\\u0003 LQ\u0003 DGROHVFHQW\u0003 SDWLHQWV\u0003 LQFOXGH\u0003 V\\PSWRP\u0003\n\n89Endometriosis in adolescents\nUHOLHI\u000f\u0003 VORZLQJ\u0003 GLVHDVH\u0003 SURJUHVVLRQ\u000f\u0003 DQG\u0003 SURWHFWLQJ\u0003\nIXWXUH\u0003IHUWLOLW\\\u0011\u0003\nCoQÀLFW o I I QWeresW 6WDWePeQW: The authors declare no \nFRQÀLFWV\u0003RI\u0003LQWHUHVW\u0003UHODWHG\u0003WR\u0003WKLV\u0003ZRUN\u0011\nFunding:\u00037KH\u0003DXWKRUV\u0003GLG\u0003QRW\u0003UHFHLYH\u0003DQ\\\u0003¿QDQFLDO\u0003VXSSRUW\u0003\nIURP\u0003DQ\\\u0003RUJDQL]DWLRQ\u0003IRU\u0003WKLV\u0003UHVHDUFK\u0003ZRUN\u0011\n(WKiFDO sWDWePenW: This study has been performed in ac-\ncordance with the ethical standards as laid down in the \n'HFODUDWLRQ\u0003RI\u0003+HOVLQNL\u0011\nREFERENCES\n1. 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/DPFHYD\u0003-\u000f\u00038OMDQRYV\u00035\u000f\u00036WUXPID\u0003,\u0011\u00037KH\u00030DLQ\u00037KHRULHV\u0003RQ\u0003WKH\u0003\n3DWKRJHQHVLV\u0003RI\u0003(QGRPHWULRVLV\u0011\u0003,QW\u0003-\u00030RO\u00036FL\u0011\u0003\u0015\u0013\u0015\u0016\u001e\u0015\u0017\u000b\u0018\f\u001d\u0017\u0015\u0018\u0017\u0011\u0003\u0003\n5. /D]]HUL\u0003 /\u000f\u0003$QGHUVVRQ\u0003 ./\u000f\u0003$QJLRQL\u0003 6\u000f\u0003 HW\u0003 DO\u0011\u0003 +RZ\u0003 WR\u0003 0DQDJH\u0003\n(QGRPHWULRVLV\u0003 LQ\u0003 $GROHVFHQFH\u001d\u0003 7KH\u0003 (QGRPHWULRVLV\u0003 7UHDW\u0010\nPHQW\u0003 ,WDOLDQ\u0003 &OXE\u0003 $SSURDFK\u0011\u0003 -\u0003 0LQLP\u0003 ,QYDVLYH\u0003 *\\QHFRO\u0011\u0003\n\u0015\u0013\u0015\u0016\u001e\u0016\u0013\u000b\u001b\f\u001d\u0019\u0014\u0019\u0010\u0019\u0015\u0019\u0011\u0003\n6. $XGHEHUW\u0003$\u000f\u0003/HFRLQWUH\u0003/\u000f\u0003$IRUV\u0003.\u000f\u0003HW\u0003DO\u0011\u0003$GROHVFHQW\u0003HQGRPH\u0010\nWULRVLV\u001d\u00035HSRUW\u0003RI\u0003D\u0003VHULHV\u0003RI\u0003\u0018\u0018\u0003FDVHV\u0003ZLWK\u0003D\u0003IRFXV\u0003RQ\u0003FOLQLFDO\u0003\nSUHVHQWDWLRQ\u0003DQG\u0003ORQJ\u0010WHUP\u0003LVVXHV\u0011\u0003-\u00030LQLP\u0003,QYDVLYH\u0003*\\QHFRO\u0003\n\u0015\u0013\u0014\u0018\u001e\u0015\u0015\u001d\u001b\u0016\u0017\u0010\u0017\u0013\u0011\n\u001a\u0011\u0003 6WXSDULFK\u0003 0$\u000f\u0003 'RQQHOODQ\u0003 1\u000f\u0003 6DQ¿OLSSR\u0003 -\u0011\u0003 (QGRPHWULRVLV\u0003 LQ\u0003\nWKH\u0003DGROHVFHQW\u0003SDWLHQW\u0011\u00036HPLQ\u00035HSURG\u00030HG\u0003\u0015\u0013\u0014\u001a\u001e\u0016\u0018\u001d\u0014\u0013\u0015\u0010\u001c\u0011\n8. 6KDIULU\u0003$/\u000f\u0003 )DUODQG\u0003 /9\u000f\u0003 6KDK\u0003 '.\u000f\u0003 HW\u0003 DO\u0011\u0003 5LVN\u0003 IRU\u0003 DQG\u0003 FRQVH\u0010\nTXHQFHV\u0003 RI\u0003 HQGRPHWULRVLV\u001d\u0003 $\u0003 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