Stepwise Minimally Invasive Approach to the Diagnosis and Treatment of Adolescent Endometriosis

Background: Early onset endometriosis (EOE) starting around menarche or early adolescence, originating from neonatal uterine bleeding. It can be progressive and severe and, if left untreated, may jeopardize future fertility of a young patient. EOE represents a condition necessitating early diagnosis and stepwise management. This study was conducted to examine a stepwise minimally invasive approach to the diagnosis and treatment of adolescent endometriosis.Methods: Electronic databases PUBMED, SCOPUS and CENTRAL were searched using the following mixture of terms: endometriosis, endometrioma, adolescent, teenager, juvenile, dysmenorrheal and pelvic pain.Findings: In summary, a stepwise minimally invasive approach to the diagnosis and treatment of adolescent endometriosis consists of the following steps: taking the patient’s history, clinical examination, imaging evaluation and management. In management phase, if ultrasound is negative or show a small/unilateral cyst, medical treatment with NSAID, progestins, or hormonal contraception should be started. When symptoms are eliminated with this medication, regular follow-up every 6–12 months is recommended. Otherwise MRI or laparoscopy should be considered. In case of severe/bilateral endometriosis in ultrasound, patients should be referred to experienced surgeons for laparoscopy and cryopreservation of ovarian tissue. Prescribing medication after minimally invasive surgery should be considered.Conclusion: Better use of modern imaging techniques will aid considerably in screening for the presence of EOE. Traditional laparoscopy should be limited to cases in which imaging gives rise to suspicion of severity and a stepwise, minimally invasive approach should be used, followed by medical treatment to prevent recurrence.

Keywords:

adolescent endometriosis , minimally invasive approach , endometriosis , adolescent , dysmenorrhea