Endometriosis in adolescents

Erica C Dun; Kimberly A Kho; Vadim V Morozov; Susan Kearney; Jonathan L Zurawin; Ceana H Nezhat

doi:10.4293/JSLS.2015.00019

Endometriosis Diagnosis

Endometriosis in adolescents

Dun EC, Kho KA, Morozov VV, Kearney S, Zurawin JL, Nezhat CH

JSLS : Journal of the Society of Laparoendoscopic Surgeons, 19(2), 2015

DOI 10.4293/JSLS.2015.00019 PMID 26005317 PMC PMC4432718

RRM Academy Synopsis

In 25 adolescents, endometriosis diagnosis took a mean 22.8 months

In this 25-girl series, endometriosis was diagnosed a mean of 22.8 months after symptoms began. This case series from one surgical center covered girls aged 21 or younger whose pelvic pain had not responded to medical treatment. They saw a median of 3 physicians first. At 1 year, 8 out of 10 reported resolved or improved pain.

8 in 10 girls reported resolved or improved pain a year after surgery. Source: Dun EC et al., 2015, PMID 26005317.

Study at a glance, case series of 25 adolescent girls: Endometriosis diagnosis took a mean of 22.8 months in adolescents. Source: Dun EC et al., 2015, PMID 26005317.

Key Findings

Symptoms began a mean of 22.8 months (standard deviation 31.0, range 1 to 132) before diagnosis.
The first physician visit came a mean of 10.9 months (standard deviation 22.0, range 1 to 108) before diagnosis.
The median number of physicians who evaluated the pain was 3 (2.3) (range, 1 to 12). Eleven of the 25 girls (44%) had visited an emergency department for pelvic pain.
Disease was stage I in 68%, stage II in 20% and stage III in 12%. None had stage IV disease. Atypical lesions were the most common finding at laparoscopy.
A year after surgery, pain had resolved for 64%, improved for 16% and continued for 12%. Another 8% said it improved first and then came back.

Interpretation

This retrospective case series followed 25 adolescent girls with pelvic pain that had not responded to medical treatment, treated by one surgeon at one tertiary referral center. The girls saw a median of 3 physicians before diagnosis, and most had resolved or improved pain a year after surgery. The authors note that a case series limits significant conclusions. The findings support larger studies of diagnostic delay and surgical outcomes in adolescent endometriosis.

RRM Context

RRM treats a long road to diagnosis as a clinical failure. Surgery here mixed excision with ablation; afterward, 64% of the girls received combined oral contraceptives, a suppressive medication. The authors name excision versus ablation as a question for future work. Their introduction links early diagnosis to preventing disease progression and protecting fertility.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background and Objectives

Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to describe the experience of adolescents who underwent laparoscopy for pelvic pain and were diagnosed with endometriosis: specifically, the symptoms, time from onset of symptoms to correct diagnosis, number and type of medical professionals seen, diagnosis, treatment, and postoperative outcomes.

Methods

We reviewed a series of 25 females ≤21 years of age with endometriosis diagnosed during laparoscopy for pelvic pain over an 8-year period. These patients were followed up for 1 year after surgery.

Results

The mean age at the time of surgery was 17.2 (2.4) years (range, 10-21). The most common complaints were dysmenorrhea (64%), menorrhagia (44%), abnormal/irregular uterine bleeding (60%), ≥1 gastrointestinal symptoms (56%), and ≥1 genitourinary symptoms (52%). The mean time from the onset of symptoms until diagnosis was 22.8 (31.0) months (range, 1-132). The median number of physicians who evaluated their pain was 3 (2.3) (range, 1-12). The adolescents had stage I (68%), stage II (20%), and stage III (12%) disease. Atypical endometriosis lesions were most commonly observed during laparoscopy. At 1 year, 64% reported resolved pain, 16% improved pain, 12% continued pain, and 8% recurrent pain.

Conclusions

Timely referral to a gynecologist experienced with laparoscopic diagnosis and treatment of endometriosis is critical to expedite care for adolescents with pelvic pain. Once the disease is diagnosed and treated, these patients have favorable outcomes with hormonal and nonhormonal therapy.

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

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.

22 min read

Topics

Endometriosis › Diagnosis › Diagnostic Delay · General Gynecology › Pelvic Pain › Chronic Pelvic Pain

Erica C Dun, Kimberly A Kho, Vadim V Morozov, Susan Kearney, Jonathan L Zurawin, Ceana H Nezhat

E Dun, K Kho, V Morozov, Sue Kearney, S Kearney, Jon Zurawin, J Zurawin, C Nezhat

PMID 26005317 26005317 DOI 10.4293/JSLS.2015.00019 10.4293/JSLS.2015.00019 Dun et al. 2015, Dun 2015

Keywords

Adolescent endometriosis, Atypical endometriosis, Endometriosis, Pelvic pain, Referral pattern

Endometriosis in adolescents

In 25 adolescents, endometriosis diagnosis took a mean 22.8 months

Key Findings

Interpretation

RRM Context

Abstract

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Topics

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Keywords