Obstetrics & Gynaecology Forum Volume 29 | Issue 3 | 2019

Introduction Endometriosis is a gynaecological condition defined by the presence of endometrial glands and stroma outside the uterus. It has been estimated to affect 10% to 15% of all reproductive–age women and 70% of women with chronic pelvic pain. 1, 2 Symptoms associated with endometriosis include menstrual pain, chron- ic and severe pelvic pain, dyspareunia and subfertility. To date, in spite of all the research that has been conducted in the last 4 decades, the aetiology of this condition remains to be elucidated making proper management all the more challenging. Various theories have been proposed regarding the pathogenesis of the disease which includes hormonal, environmental, immunological and genetic factors. The condition is conventionally diagnosed by visual inspection during laparoscopy and confirmed by histology. 3 Delays in the diagnosis of endometriosis often occur in teenagers because of the deferring of laparoscopy which can adversely affect reproductive potential and functional outcomes. 4 Endometriosis was described in teenagers in the 1940’s and the traditional belief was that it was uncommon in younger women. However, with awareness of this condition and better understand- ing of symptoms, this has led to an increasing number of cases being diagnosed during the past 2 decades. 5 Indeed, it has been reported that most women with endometriosis first experienced symptoms in their teenage years. 6 Adolescent endometriosis encompasses many challenging issues with regard to pathophys- iology, delay in diagnosis, long-term evolution and management. The scientific literature on adolescent endometriosis is lacking and the need for future research is urgently required. The review aims to present characteristics and management of endometriosis in adolescents. Prevalence The prevalence of endometriosis in adolescence is not exactly known and is variable based depending on the selection criteria used. It is estimated that one-third of adolescents with chronic pelvic pain and 80% of adolescents with chronic pelvic pain who failed to respond to medical treatment (oral contraceptive pills and non-steroidal anti-inflammatory drugs) have endometriosis. 7 Several factors potentially hinder the diagnosis: adolescents may present with different symptoms than that seen in adults and phy- sicians are reluctant to operate on this age group. In a study by Bai et al, endometriosis was diagnosed as an incidental finding in 10% of adolescents without symptoms. 8 Diagnosis There is a general feeling that endometriosis is a hidden, progres- sive and severe disease that deserves attention in adolescents. 9 There is a delay of up to 12 years in the diagnosis of endome- triosis in this age group. 7 In a study by Hadfield et al, length of time between onset of pain symptoms and the surgical diagnosis of endometriosis was 11.73 years in the USA. 10 Currently, there is no accurate non-invasive diagnostic test which is specific for endometriosis, hence diagnosis can only be made at laparosco- py. The diagnosis by laparoscopy is almost always postponed for several years by which time destructive lesions have affected the tubo-ovarian structures and compromised fecundability. Ballweg S.R. Ramphal 1 1 Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa Adolescent Endometriosis Abstract The prevalence of endometriosis is estimated to be about one-third of adolescents with chronic pelvic pain and increases to up to 80% in adolescents with chronic pelvic pain who fail to respond to medical treatment. The most common presenting symptom is dysmenorrhea and chronic pelvic pain. Acyclic pain is more common in adolescents than in adults. Atypical and subtle lesions are seen with red lesions being the commonest. The majority have early stage disease but a significant proportion (up to 30%) have advanced disease. An ovarian endometrioma is the most common presentation with advanced disease. Management is challenging and includes distraught parents and patient. Surgery is beneficial in treating pain with all stages of endometriosis and improving fertility in adolescents with infertility. Optimal and complete laparoscopic excision might slow disease progression. Postoperative medical therapy may have benefit to treat endometriosis pain but is not conclusive with regard to preventing disease progression or recurrence. Keywords: Adolescent endometriosis, Dysmenorrhea, Endometriomas, Infertility, Laparoscopy Correspondence Dr S.R. Ramphal email: ramphals1@ukzn.ac.za O&G Forum 2019; 29: 15 - 18 REVIEW OBSTETRICS & GYNAECOLOGY FORUM 2019 | ISSUE 3 | 15