Severe dysmenorrhea in adolescents need non-invasive ultrasound evaluation to early detect endometriosis/adenomyosis

OBJECTIVE: To evaluate the prevalence of ovarian endometriosis, deep infiltrating endometriosis (DIE), and adenomyosis in adolescents (12-20 years) with severe dysmenorrhea based on specific ultrasound findings. METHODS: This retrospective study included 267 adolescents (aged 12-20) with severe dysmenorrhea (Visual analog scale-VAS- score ≥7), referred to our Gynecological Ultrasound Unit. All underwent two-dimensional (2D), three-dimensional (3D), and power Doppler ultrasound (US) pelvic examinations. Medical history, painful symptoms and heavy menstrual bleeding (HMB) were recorded. Endometriosis locations, whether isolated or combined, were documented using a dedicated US mapping sheet. RESULTS: Ultrasonographic signs of endometriosis or adenomyosis were identified in 106 adolescents (39.7 %), while 114 (42.7 %) showed normal scans despite severe dysmenorrhea. Ovarian endometriomas were observed in 26 cases (24.5 %). Adenomyosis was detected in 47 patients (44.3 %). Posterior DIE was identified in 60 patients (56.6 %), and fibrotic thickening of the uterosacral ligaments (USL) was noted in 58 cases (54.7 %). No statistical differences in lesion distribution emerged between age groups, except for a higher rate of coexisting endometriosis and adenomyosis in those aged 17-20 vs. 12-16 (11.1 % vs. 1.9 %, p = 0.03). Adolescents with US signs of disease more frequently reported dysmenorrhea with at least one additional painful symptom or HMB (p = 0.001). Study limitations include the retrospective design, age group imbalance and potential limited generalizability due to the exclusive use of expert sonographers. CONCLUSIONS: About 40% of adolescents with severe dysmenorrhea had ultrasound signs of endometriosis or adenomyosis, often limited to mild forms. Early referral to expert sonographers is key for timely diagnosis and management.