CLINICAL CHARACTERISTICS OF ADOLESCENT ENDOMETRIOSIS

Our study objective was to describe the appearance, stage, and treatment of endometriosis in adolescents undergoing laparoscopic treatment of severe dysmenorrhea and endometriosis. We designed a retrospective analysis of adolescents with endometriosis whose primary symptom was severe dysmenorrhea. We studied patients in a private practice associated with a residency program. Forty-nine adolescents with histologically confirmed endometriosis underwent laparoscopy. Thirty-six of these patients (mean age, 16.6 +/- 1.4 years; range, 13-20 years) presented with severe dysmenorrhea in a nonemergency state and were refractory to prior therapy. All patients underwent laparoscopic surgery. We classified endometriosis implants as typical implants, red lesions, and occult lesions in thirty-six adolescents. We excised infiltrating lesions (defined as implants penetrating greater than 3-5 mm) and vaporized or coagulated superficial lesions (defined as surf ace implants or those penetrating <3 mm). All adolescents underwent postsurgical ovulation suppression with a daily birth control pill. The need for reoperation at any time or the use of GnRH analogs, Danazol, or large doses of progestins served to indicate treatment failure. The presence or absence of red lesions was recorded in this group and compared to the presence or absence of such lesions in an older population of patients undergoing definitive therapy for endometriosis during the same time period. Our results showed that red lesions are the predominant implant type in adolescents. Adolescents with cyclic pain and those who complain of abdominal pain, nausea, constipation, and diarrhea during menses had the largest proportion of red lesions. When compared to forty-six women age 31-46 years (mean age, 37.4 +/- 3.4 years) significantly more red lesions were present in adolescents. Satisfactory resolution of symptoms occurs in 84% of adolescents treated by operative laparoscopy and ovulation suppression with a daily birth control pill. [At follow-up 6 months to 6 years (mean, 2.8 +/- 1.2 years).]