ALGORITHM FOR DIAGNOSIS AND MANAGEMENT OF ADOLESCENT GIRLS WITH GENITAL ENDOMETRIOSIS

Khashchenko E.P. Khashchenko; Uvarova E.V. Uvarova

doi:10.18565/aig.2025.355

ALGORITHM FOR DIAGNOSIS AND MANAGEMENT OF ADOLESCENT GIRLS WITH GENITAL ENDOMETRIOSIS

Khashchenko E.P. Khashchenko, Uvarova E.V. Uvarova

In: Akusherstvo i ginekologiia · 2025 · vol. 12_2025 , pp. 4–8 · doi:10.18565/aig.2025.355 · W7117566924

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This paper presents an algorithm for the diagnosis and management of genital endometriosis in adolescent girls.

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This paper presents a clinical algorithm for the diagnosis and management of genital endometriosis specifically in adolescent girls, drawing upon international guidelines from ACOG, NICE, and ESHRE alongside Russian national recommendations. The authors outline a diagnostic framework that emphasizes early recognition of symptoms such as dysmenorrhea and chronic pelvic pain, advocating for imaging techniques like ultrasound while noting limitations in detecting superficial lesions. Treatment strategies discussed include medical management with hormonal therapies to suppress menstruation and alleviate pain, with surgical intervention reserved for cases refractory to conservative treatment or when severe pathology is confirmed. This paper is centrally about endometriosis — specifically focused on establishing diagnostic and therapeutic protocols for adolescent patients with genital endometriosis.

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АЛГОРИТМ ДИАГНОСТИКИ И ВЕДЕНИЯ ДЕВОЧЕК‑ПОДРОСТКОВ С ГЕНИТАЛЬНЫМ ЭНДОМЕТРИОЗОМ Хащенко Е.П., Уварова Е.В. Для цитирования: Хащенко Е.П., Уварова Е.В. Алгоритм диагностики и ведения девочек-подростков с генитальным эндометриозом. Акушерство и гинекология. 2025; 12 (Приложение): 4-8 https://dx.doi.org/10.18565/aig.2025.355 Список литературы 1. ACOG Committee Opinion No. 760: Dysmenorrhea and Endometriosis in the Adolescent. Obstet. Gynecol. 2018; 132(6): e249‑58. https://dx.doi.org/10.1097/ AOG.0000000000002978 2. NICE. Endometriosis: diagnosis and management. NICE guideline. London: National Institute for Health and Care Excellence; 2024. 32 p. Available at: https:// www.ncbi.nlm.nih.gov/books/NBK604070/pdf/Bookshelf_NBK604070.pdf 3. Becker C.M., Bokor A., Heikinheimo O., Horne A., Jansen F., Kiesel L. et al. ESHRE guideline: endometriosis. Hum. Reprod. Open. 2022; 2022(2): hoac009. https:// dx.doi.org/10.1093/hropen/hoac009 4. Yeung P. Jr., Gupta S., Gieg S. Endometriosis in adolescents: A systematic review. J. Endometr. Pelvic Pain Disord. 2017; 9(1): 17‑29. https://dx.doi.org/10.5301/ je.5000264 5. Laganà A.S., Garzon S., Götte M., Viganò P., Franchi M., Ghezzi F. et al. The Pathogenesis of endometriosis: molecular and cell biology insights. Int. J. Mol. Sci. 2019; 20(22): 5615. https://dx.doi.org/10.3390/ijms20225615 6. Lee H.C., Lin S.C., Wu M.H., Tsai S.J. Induction of pyruvate dehydrogenase kinase 1 by hypoxia alters cellular metabolism and inhibits apoptosis in endometriotic stromal cells. Reprod. Sci. 2019; 26(6): 734‑44. https://dx.doi.org/10.1177/1933719118789513 7. Kazmi I., Alharbi K.S., Al-Abbasi F.A., Almalki W.H., G S.K., Yasmeen A. et al. Role of epithelial‑to‑mesenchymal transition markers in different stages of endometriosis: Expression of the Snail, Slug, ZEB1, and Twist Genes. Crit. Rev. Eukaryot. Gene Expr. 2021; 31(2): 89‑95. https://dx.doi.org/10.1615/CritRevEuk aryotGeneExpr.2021037996 8. Khashchenko E.P., Vysokikh M.Y., Marey M.V., Sidorova K.O., Manukhova L.A., Shkavro N.N. et al. Altered glycolysis, mitochondrial biogenesis, autophagy and apoptosis in peritoneal endometriosis in adolescents. Int. J. Mol. Sci. 2024; 25(8): 4238. https://dx.doi.org/10.3390/ijms25084238 9. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Эндометриоз. М.; 2024. 32 с. 10. Exacoustos C., Lazzeri L., Martire F.G., Russo C., Martone S., Centini G. et al. Ultrasound findings of adenomyosis in adolescents: type and grade of the disease. J. Minim. Invasive Gynecol. 2022; 29(2): 291‑299.e1. https://dx.doi.org/10.1016/j.jmig.2021.08.023 11. Gkrozou F., Vatopoulou A., Skentou C., Paschopoulos M. Diagnosis and treatment of adenomyosis with office hysteroscopy‑A narrative review of literature. Diagnostics (Basel). 2023; 13(13): 2182. https://dx.doi.org/10.3390/diagnostics13132182 12. Gordts S., Grimbizis G., Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertil. Steril. 2018; 109(3): 380‑388.e1. https://dx.doi.org/10.1016/j.fertnstert.2018.01.006 13. Ebert A.D., 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(5): 560‑7. https://dx.doi.org/10.1016/j.jpag.2017.01.014 14. Maiorana A., Maranto M., Restivo V., Gerfo D.L., Minneci G., Mercurio A. et al. Evaluation of long‑term efficacy and safety of dienogest in patients with chronic cyclic pelvic pain associated with endometriosis. Arch. Gynecol. Obstet. 2024; 309(2): 589‑97. https://dx.doi.org/10.1007/s00404‑023‑07271‑7. Об авторах / Для корреспонденции Хащенко Елена Петровна, к.м.н., в.н.с. 2-го гинекологического отделения, НМИЦ АГП им. В.И. Кулакова Минздрава России, 117997, Россия, Москва, ул. Ак. Опарина, д. 4, [email protected]Уварова Елена Витальевна, чл.-корр. РАН, д.м.н., профессор, главный внештатный специалист гинеколог детского и юношеского возраста Минздрава России; заведующая 2-м гинекологическим отделением Института неонатологии и педиатрии, НМИЦ АГП им. В.И. Кулакова Минздрава России, 117997, Россия, Москва, ул. Ак. Опарина, д. 4; президент Ассоциации детских и подростковых гинекологов, заслуженный деятель науки РФ, elena [email protected]

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