Endometriosis in Younger Unmarried Girls

The incidence and severity of endometriosis in adolescent girls are comparable with the incidence of adult women. The mean delay between the onset of symptoms and the final diagnosis varies between 6.4 to 11.7 years. The longer the diagnosis is delayed, the more the endometriosis can progress to a more severe stage compromising on the ovarian reserve and fertility potential in the later stage. The severity of the disease is not directly related to the degree of pain.

Endometriotic cysts have a detrimental effect on the ovarian reserve by the evolution in time and the surgical excision technique. Therefore the early diagnosis of endometriosis in adolescents deserves our full attention.

2D/3D imaging techniques are helpful in early diagnosis. Early ablative surgery is recommendable. Although laparoscopy is traditionally recommended, transvaginal laparoscopy has been shown to be most effective in ablating endometriomas with a maximum diameter of 3 cm. Early detection and intervention will contribute to a better quality of life in these adolescents and also to lower damage of the ovarian tissue by a less invasive ablative surgery.

The young girls who present with severe dysmenorrhoea, chronic pelvic pain, bowel and bladder disturbances, menorrhagia with pain, GI symptoms during periods should be investigated for the presence of pelvic endometriosis. Early-stage management of endometriosis in the adolescent involves exclusion of reproductive tract anomaly, monitoring the response of pelvic pain to medical treatment (NSAID, OC pills, progestin) and the U/S diagnosis of an endometrioma and in such cases full ablative surgery of the ectopic endometrial tissue.

It is true that the progressivity of the disease cannot be predicted, but adolescents with ablative surgery should be meticulously followed up for recurrence and progression to severe stage IV endometrioma and frozen pelvis.

The recent study by Young et al suggested that complete Laparoscopic excision of all areas of abnormal peritoneum with typical and atypical endometriosis has the potential to eradicate the disease.

Decisions to operate should be carefully balanced against the growing concern of potential damage of surgery upon the ovarian reserve. Endometrial cells on the surface of the ovary carry the risk to affect the ovary in 2 ways. First, by causing ovarian adhesion and pseudo cysts and secondly by causing mesenchymal cell metaplasia in the interstitial ovarian tissue, sclerosis and follicle loss similar to oncology, there is no reason to wait.

Further research has to be done to find out if such early treatment will result in a lower recurrence rate and less severe form of the disease.