Advances in the management of endometriosis in the adolescent

Mama ST, Saifuddin T. Mama
Current opinion in obstetrics & gynecology · 2018 · vol. 30(5) , pp. 326–330 · doi:10.1097/gco.0000000000000483 · PMID:30153130 · W2889112764
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This review outlines the molecular basis of adolescent endometriosis, highlighting delayed diagnosis and proposing tailored medical and surgical treatments for symptom relief.

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Abstract

PURPOSE OF REVIEW: The present article provides an overview of the molecular mechanisms underlying adolescent endometriosis and advances in both medical and surgical management. RECENT FINDINGS: Molecular and cellular features of endometriotic lesions differ from eutopic endometrium. There is altered estrogen-mediated cell signaling, proinflammatory pathways develop in the local microenvironment, along with impaired cellular immunity and growth factors, cytokines, and angiogenic factors play a critical role. This leads to proliferation and invasion by ectopic endometrial tissue, and natural clearance by the immune system fails. The inflammation, scarring, and adhesions are symptomatically expressed as dysmenorrhea, pelvic pain, and dyspareunia significantly compromising quality of life.In adolescence, there is a significant delay in diagnosis, often because of physician nonresponsiveness. The social, emotional, and physical impact on adolescents is underestimated. Medical management aimed at cessation of menses is paramount, if surgical management is needed, the goal is maximal excision. A variety of new medications, including GnRH and progesterone antagonists, selective estrogen and progesterone receptor modulators, aromatase inhibitors, statins, angiogenic inhibitors, and botanicals represent future treatment options. SUMMARY: Early diagnosis of adolescent endometriosis is critical. An understanding of the complex proinflammatory pathways underlying its progression and tailored medical-surgical treatment offers the greatest potential to decrease disease symptomatology.

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Condition tags

endometriosisdysmenorrheadyspareunia

MeSH descriptors

Endometriosis Endometriosis Adolescent Endometriosis Endometriosis Endometriosis Female Humans Prevalence Psychology Risk Factors

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (33)

Cited by (20)

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License: CC0 · commercial use OK