Goldstein, D. P., De Cholnoky, C., & Emans, S. J. (1980). Adolescent endometriosis. Journal of Adolescent Health Care : Official Publication of the Society for Adolescent Medicine, 1(1), 37-41. https://doi.org/10.1016/s0197-0070(80)80007-6
Goldstein DP, De Cholnoky C, Emans SJ. Adolescent endometriosis. J Adolesc Health Care. 1980;1(1):37-41. doi:10.1016/s0197-0070(80)80007-6
Goldstein, Donald P., et al. "Adolescent endometriosis." Journal of Adolescent Health Care : Official Publication of the Society for Adolescent Medicine, vol. 1, no. 1, 1980, pp. 37-41.
Endometriosis found in 47% of teens who had laparoscopy for pain
Biopsy found endometriosis in about 5 out of 10 teenagers referred for chronic pelvic pain. In a 1980 Boston case series, 140 teenagers had laparoscopy after three or more visits without a diagnosis. Among the 66, the diagnosis had not been made before surgery in most.
Key Findings
Laparoscopy with peritoneal biopsy confirmed endometriosis in 66 of 140 adolescent girls (47%). All 140 had chronic pelvic pain and at least three visits without a diagnosis.
In the 66, pain began on average 2.9 years after menarche. It was cyclic in 42 (64%) and acyclic in 24 (36%), and severe enough to stop normal activities in 24 (36%).
Eleven of the 66 (17%) had normal pelvic examinations. In 13 (20%), all stage I, the lesions looked atypical and only biopsy confirmed them. Psychiatric evaluation was recommended for 10.
Stage I disease affected 38 of 66 (58%). Stage IIA affected 15 (23%), stage IIB 10 (15%) and stage IV 3 patients.
Satisfactory response: 12 of 24 (50%) in group I (diagnostic laparoscopy, mainly ovulation suppression), 19 of 27 (70%) in group II (operative laparoscopy), 12 of 15 (80%) in group III (conservative laparotomy).
Interpretation
This case series followed 140 teenage girls with chronic pelvic pain at a Boston hospital from 1974 to 1979. Follow-up ran from 3 months to 5.25 years. Girls with more disease more often had surgery. Girls with less disease more often had ovulation suppression. Response rates were lowest for diagnostic laparoscopy and highest for conservative laparotomy, as shown above. The authors note that endometriosis often goes away on its own and can come back later. The findings support larger studies with longer follow-up.
RRM Context
Restorative Reproductive Medicine puts evaluation before treatment. Repeat exams and gut and urine tests missed the disease here. Laparoscopy with biopsy found it. Some girls had normal pelvic exams even though biopsy proved endometriosis. Ten girls were sent for psychiatric evaluation instead. This is why root-cause evaluation matters before symptoms get dismissed.
Our editorial summary of this paper, not the article's abstract.
Abstract
Endometriosis was encountered in 66 of 140 patients (47%) who underwent laparoscopy for chronic pelvic pain at Boston Children's Hospital Medical Center. Pelvic pain associated with this diagnosis was both cyclic and acyclic and typically began 2.9 years after menarche. Other symptoms included irregular menses, gastrointestinal and bladder symptoms, and increased vaginal discharge. The diagnosis of endometriosis had not been made preoperatively in the majority of patients despite repeated pelvic examinations and thorough evaluation of the gastrointestinal and urinary tracts. Psychiatric referral had been recommended for 10 patients. The most constant physical finding preoperatively was tenderness with or without cul-de-sac nodularity. Eleven patients (17%) with biopsy-proved endometriosis has normal pelvic examinations. Fifty-eight percent of patients had early and minimal disease (stage I). In the remaining patients, the disease was more extensive, involving the ovaries, tubes, and/or adjacent pelvic structures (stages II-IV). Although in most instances the implants were typical in appearance, in 13 patients (20%) the disease was not recognizable grossly, but was confirmed morphologically. The regimens utilized as primary treatment were based on the stage of the disease and consisted of either ovulation suppression alone or surgery with or without subsequent ovulation suppression. A satisfactory outcome was achieved in 47 patients (71%). The remaining 19 patients (28%) who did not respond to primary treatment were either operated on or treated symptomatically and are being carefully followed.
Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.
