Adolescents and endometriosis

It may be difficult to diagnose endometriosis in adolescents with pelvic pain merely on the basis of history, as similar symptoms occur in patients evaluated laparoscopically for pelvic pain with and without endometriosis. Also, around 60% of adult women with endometriosis report symptoms beginning at <20 years of age or even earlier. It is a common misbelief that endometriosis presents only after many years of menstruation. Hence, during evaluation of an adolescent with significant pelvic pain, whether cyclic or acyclic, endometriosis must be kept as a differential to avoid delay in diagnosis and management. The estimated prevalence depends upon whether a symptomatic or an asymptomatic population is being studied and upon the method used for diagnosis. Around 20%–30% of adolescents with chronic pelvic pain and around half of those undergoing laparoscopy for this pain will be diagnosed to have this condition. However, laparoscopy for the sole purpose of diagnosing endometriosis is not warranted in all adolescents with dysmenorrhea. However, pelvic pain not controlled with nonsteroidal anti-inflammatory drugs (NSAIDs) or combined oral contraceptive pills (OCPs) strongly points toward endometriosis.