Endometriosis in Premenarcheal Girls Who Do Not Have an Associated Obstructive Anomaly

Approximately two thirds of adolescent girls with pelvic pain that does not respond to medical treatment have endometriosis. The authors present 5 premenarcheal girls having chronic pelvic pain for longer than 6 months and a negative gastrointestinal workup. None of them had an obstructive abnormality of the reproductive tract when examined under anesthesia. The girls, 8.5 to 13 years of age, had a degree of pain that interfered with their daily activities. None of them had been operated upon. All 5 girls had clear, red, and/or white lesions resembling stage I endometriosis according to the American Society for Reproductive Medicine Classification of Endometriosis. Lesions seen on biopsies of visible lesions included vascular proliferation, deposits of hemosiderin, proliferating macrophages, stroma without glands, inflammation, granulation, endosalpingiosis, and adhesions. All 5 patients were operated upon, having resection, laser treatment, and/or cautery of visible lesions. All of them had markedly less pelvic pain postoperatively. None of the girls received hormonal antiendometriosis treatment until spontaneous menarche had begun. The interval from diagnosis to the onset of menses ranged from 1 to 44 months. At menarche, the patients received combination low-dose monophasic estrogen–progestin pills continuously. Two girls had a second laparoscopy because of worsening pelvic pain that did not respond to hormonal treatment; endometriosis was confirmed by biopsy in these cases. Premenarcheal girls with chronic pelvic pain may have endometriosis (or an antecedent condition) in the absence of any obstructive anomaly. The findings strongly support the idea that, in some cases, endometriosis may result from something other than retrograde menses.