title: Endometriosis in adolescents.
abstract: OBJECTIVE
  Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to describe the experience of adolescents who underwent laparoscopy for pelvic pain and were diagnosed with endometriosis: specifically, the symptoms, time from onset of symptoms to correct diagnosis, number and type of medical professionals seen, diagnosis, treatment, and postoperative outcomes.
  
  
  METHODS
  We reviewed a series of 25 females ≤21 years of age with endometriosis diagnosed during laparoscopy for pelvic pain over an 8-year period. These patients were followed up for 1 year after surgery.
  
  
  RESULTS
  The mean age at the time of surgery was 17.2 (2.4) years (range, 10-21). The most common complaints were dysmenorrhea (64%), menorrhagia (44%), abnormal/irregular uterine bleeding (60%), ≥1 gastrointestinal symptoms (56%), and ≥1 genitourinary symptoms (52%). The mean time from the onset of symptoms until diagnosis was 22.8 (31.0) months (range, 1-132). The median number of physicians who evaluated their pain was 3 (2.3) (range, 1-12). The adolescents had stage I (68%), stage II (20%), and stage III (12%) disease. Atypical endometriosis lesions were most commonly observed during laparoscopy. At 1 year, 64% reported resolved pain, 16% improved pain, 12% continued pain, and 8% recurrent pain.
  
  
  CONCLUSIONS
  Timely referral to a gynecologist experienced with laparoscopic diagnosis and treatment of endometriosis is critical to expedite care for adolescents with pelvic pain. Once the disease is diagnosed and treated, these patients have favorable outcomes with hormonal and nonhormonal therapy.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Erica C
authors.initials: EC
authors.lastname: Dun
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kho
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Vadim V
authors.initials: VV
authors.lastname: Morozov
authors.affiliation: Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Kearney
authors.affiliation: Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Zurawin
authors.affiliation: Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia, USA.
authors.forename: Ceana H
authors.initials: CH
authors.lastname: Nezhat
mesh_terms: D000293:Adolescent; D000328:Adult; D004412:Dysmenorrhea / Q000209:etiology / Q000601:surgery; D004715:Endometriosis / Q000145:classification / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008595:Menorrhagia / Q000209:etiology / Q000601:surgery; D017699:Pelvic Pain / Q000209:etiology / Q000601:surgery; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult
keywords: Adolescent endometriosis; Atypical endometriosis; Endometriosis; Pelvic pain; Referral pattern