Adolescent endometriosis

Endometriosis was encountered in 66 of 140 patients (47%) who underwent laparoscopy for chronic pelvic pain at Boston Children's Hospital Medical Center. Pelvic pain associated with this diagnosis was both cyclic and acyclic and typically began 2.9 years after menarche. Other symptoms included irregular menses, gastrointestinal and bladder symptoms, and increased vaginal discharge. The diagnosis of endometriosis had not been made preoperatively in the majority of patients despite repeated pelvic examinations and thorough evaluation of the gastrointestinal and urinary tracts. Psychiatric referral had been recommended for 10 patients. The most constant physical finding preoperatively was tenderness with or without cul-de-sac nodularity. Eleven patients (17%) with biopsy-proved endometriosis has normal pelvic examinations. Fifty-eight percent of patients had early and minimal disease (stage I). In the remaining patients, the disease was more extensive, involving the ovaries, tubes, and/or adjacent pelvic structures (stages II-IV). Although in most instances the implants were typical in appearance, in 13 patients (20%) the disease was not recognizable grossly, but was confirmed morphologically. The regimens utilized as primary treatment were based on the stage of the disease and consisted of either ovulation suppression alone or surgery with or without subsequent ovulation suppression. A satisfactory outcome was achieved in 47 patients (71%). The remaining 19 patients (28%) who did not respond to primary treatment were either operated on or treated symptomatically and are being carefully followed.