Adolescent endometriosis


  • Meenu P. Nanthakumar
  • Sendhil C. Arumugam



Adolescence, Dysmenorrhea, Pelvic pain


Endometriosis is predominantly a disease of women of reproductive age group. Endometriosis is not uncommon in adolescents. Presentation tends to focus on pain, especially intractable dysmenorrhea and chronic pelvic pain. In around 60% of patients with endometriosis symptoms start in adolscence. Pain unresponsive to treatment is the usual indication for a Laproscopy. The appearance of endometriotic lesions is different from that of adults. Medical and surgical options for treatment are available. Endometriosis may be progressive and adverse effects may go beyond pain and cause infertility.


Marsh EE, Laufer MR. Endometriosis in premenarcheal girls who do not have an associated obstructive anomaly. Fertil Steril. 2005;83:758-760.

Goldstein DP, Leventhal JM, Emans SJ. New insights into the old problem of chronic pelvic pain. Journal of pediatric surgery. 1979;14(6):675-80.

Chatman DL, Ward AB. Endometriosis in adolescents. J Reprod Med. 1982;27:156-60.

Emans SH, Laufer MR, Goldstein DP. Dysmenorrhea, pelvic pain, and the premenstrual syndrome In: Pediatrics and adolescent gynecology. 4th edition. Philadelphia: Lippencott-Raven Publishers; 1997:363-410.

Ballweg ML. Big picture of endometriosis helps provide guidance on approach to teens: comparative historical data show endo starting younger, is more severe. J Pediatr Adolesc Gynecol. 2003;16(3 Suppl):S21-6.

Laufer MR. Current approaches to optimizing the treatment of endometriosis in adolescents. Gynecol Obstet Investigation. 2008;66(suppl. 1):19-27.

Geysenbergh B, Dancet EA, D’ Hooghe T. Detecting endometriosis in Adolescents: why not start from self-report screening questionnaires for adult women? Gynecol Obstet Invest. 2016 Nov 5.

Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P. Validation study of nonsurgical diagnosis of endometriosis. Fertil Steril. 2001;76:929-35.

Solnik MJ. Chronic pelvic pain and endometriosis in adolescents Current Opinion. Obstet Gynecol. 2006;18:511-8.

American College of Obstetricians and Gynecologists. Endometriosis in adolescents. ACOG Committee Opinion No. 310. Obstet Gynecol. 2005;105:921-7.

Davis GD, Thillet E, Lindemann J. Clinical characteristics of adolescent endometriosis. J Adolesc Health. 1993;14:362-8.

Vernon MW, Beard JS, Graves K, Wilson EA. Classification of endometriotic implants by morphologic appearance and capacity to synthesize prostaglandins. Fertil Steril. 1986;46:801-6.

Laufer MR. Identification of clear vesicular lesions of atypical endometriosis:a new technique. Fertil Steril. 1997;68:739-40.

Reese KA, Reddy S, Rock JA. Endometriosis in an adolescent population: the Emory experience. J Pediatr Adolesc Gynecol. 1996;9:125-8.

Winkel C, Scialli A. Medical and surgical therapies for pain associated with endometriosis. J Women’s Health Gender Based Med. 2001;10(2):137-62.

Davis L, Kennedy SS, Moore J. Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev. 2007;3:CD001019.

Vercellini P, De Giorgi O, Oldani S, Cortesi I, Panazza S, Crosignani PG. Depot medroxyprogesterone acetate versus an oral contraceptive combined with very-low-dose danazol for long-term treatment of pelvic pain associated with endometriosis. Am J Obstet Gynecol. 1996;175:396-401

Bahamondes L, Perrotti M, Castro S, Faúndes D, Petta C, Bedone A. Forearm bone density in users of depoprovera as a contraceptive method. Fertil Steril. 1999;71:849-52.

Moore J, Kennedy S, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis (Cochrane Review). In: The Cochrane Library, issue 2. Oxford: Update Software Ltd; 2002.

Surrey ES, Hornstein MD. Prolonged GnRH agonist and add-back therapy for endometriosis: long-term follow-up. Obstet Gynecol. 2002;99:709-19.

Barbieri RL. Hormone treatment of endometriosis: the estrogen threshold hypothesis. Am J Obstet Gynecol. 1992;166:740-5.

Sutton J, Ewen SP, Whitelaw N, Haines P. Prospective, randomized, double blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild and moderate endometriosis. Fertil Steril. 1994; 4:696-700.

Redwine DB. Treatment of endometriosis-associated pain. Infertil Reprod Med Clin North Am. 1993;3:697-721.

Nezhat CH, Seidman DS, Nezhat FR, Nezhat CR. Long-term outcome of laparoscopic presacral neurectomy for the treatment of central pelvic pain attributed to endometriosis. Obstet Gynecol. 1998;91:701-4.

Elizur SE, Chian RC, Holzer HE, Gidoni Y. Cryopreservation of oocytes in a young woman with severe and symptomatic endometriosis: a new indication for fertility preservation. Fertil Steril. 2009;293:e1-293.e3.

Somigliana E, Vigano P, Filippi F, Vercellini P. Fertility preservation in women with endometriosis: for all, for some, for none?. Human Reprod. 2015;30(6):1280-6.

Chwalisz K, Garg R, Brenner RM, Schubert G, Elger W. Selective progesterone receptor modulators (SPRMs): a novel therapeutic concept in endometriosis. Ann N Y Acad Sci. 2002;955:373-88.

Buelke-Sam, Bryant HU, Francis PC. The selective receptor modulator, raloxifene: an overview on non-clinical pharmacology and reproductive and developmental testing. Hum Reprod Update. 1998;6:413-8.

Bulun SE, Zeitoun K, Takayama K, Sasano H. Molecular basis of treating endometriosis with aromatase inhibitors. Hum Reprod Update. 2000;6:413-8.

Nothnick WB, Curry TE, Vernon MW. Immunomodulation of rat endometriotic implant growth and protein production. Am J Reprod Immunol. 1994;31:151-162.






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