An investigation of nerve fibres in the endometrial functional layer and peritoneal lesions of adolescents with endometriosis

Endometriosis is an enigmatic disease of uncertain aetiology and pathogenesis, characterised by the presence of endometrial-like tissue in areas outside the uterine cavity. It is a chronic disease associated with pelvic pain and subfertility. Endometriosis in adolescents presents a particular challenge of differential diagnosis and choice of treatment. The disease often begins in adolescence, but is most often recognised after years of dysmenorrhea. The combination of variable clinical presentation that is difficult to distinguish from primary dysmenorrhoea and the shortage of non-invasive methods for diagnosis has led to this delay. More recently, studies have emerged with promises of markers for endometriosis with the prospect of using this method as a less invasive definitive diagnosis for endometriosis. These studies have demonstrated the expression of sympathetic, parasympathetic, and sensory nerve fibres in the functional layer of the endometrium and peritoneal lesions of women with endometriosis. They suggest that these nerve fibres play a role in the pathophysiology of endometriosis-associated pelvic pain. There currently exist no data that discusses the innervation of peritoneal lesions or eutopic endometrium of the adolescent. Facilitating earlier diagnosis and intervention for patients with endometriosis has potential to prevent disease progression, psychological pain and preserve future fertility.