Endometriosis prevalence among adolescents with pelvic pain

Physicians should be aware of the high prevalence of endometriosis in adolescents with pelvic pain.

Key Points

Highlights:

• To prevent the delay in the treatment, primary and secondary care physicians should be aware of the high prevalence of endometriosis in adolescents with pelvic pain.

Importance:

• Since empirical treatment of pelvic pain is unsuccessful in adolescents with endometriosis, the quick referral of these patients from primary care to secondary care is substantial.

What's done here:

• This is a systematic review of the literature analyzing the prevalence of endometriosis in adolescents with pelvic pain, including 19 studies from 2011 to July 2019.

Key results:

• There are 1243 adolescents with pelvic pain across 19 studies in the literature.
• Endometriosis was detected in 648 of 1011 (64%) adolescents undergoing laparoscopy (mean prevalence: 64%, range [25%-100%]). 
• Endometriosis severity classification using the revised American Society of Reproductive Medicine appearing in 13 studies with 381 participants, revealed that 53% stage I, 28% stage II, 20% stage III, and 13% patients had stage IV disease.
• The guidance for the management of adolescents with pelvic pain and the adult population was not different.
• MRI is recommended as a useful noninvasive technique in the investigation of endometriosis in adolescents with pelvic pain, before laparoscopy.

Limitations:

• There is a wide variation in pre-test prevalence of the disease in adolescents with pelvic pain between cohorts due to the clinical heterogeneity and varying degrees of specialization of the centers.

Lay Summary

An updated review conducted by the investigators at EGA Institute for Women's Health, University College London, United Kingdom, in collaboration with Birmingham Women’s and Children’s Foundation Trust of the Institute of Metabolism and Systems Research at the University of Birmingham School of Medicine, has recently been published in Journal of Pediatric and Adolescent Gynecology. Study shows that the prevalence of endometriosis, confirmed laparoscopically or by imaging, in adolescents with pelvic pain is high.

The team led by Hirsch M. evaluated 19 studies from 2011 to July 2019, including 1243 adolescents with pelvic pain. Endometriosis was detected in 648 of 1011 adolescents undergoing laparoscopy. The mean prevalence of endometriosis was 64%, ranging from 25% to 100%. 

Categorization of endometriosis severity was made using the revised American Society of Reproductive Medicine classification in 13 studies with 381 participants. Fifty-three percent of the patients had stage I, 28% had stage II, 20% had stage III, and 13% had stage IV disease.

Based on the findings that pelvic pain associated with adolescent endometriosis is common, the authors stress the importance of rapid referral of adolescents with pelvic pain to a pediatric gynecologist by primary and secondary care physicians.

The authors underline the lack of high-quality studies investigating endometriosis in adolescents. They also indicate the requirement of an act of endometriosis organizations for producing larger researches on powerful diagnostic and therapeutic interventions for this population.

Moreover, the authors advise clinicians to consider MRI before laparoscopy as a useful noninvasive technique.

Research Source: https://pubmed.ncbi.nlm.nih.gov/32736134/