Endometriosis likely in girls with chronic pelvic pain

Nearly all adolescent girls with chronic pelvic pain that doesn’t respond to conventional medical therapy were found to have endometriosis, according to new research.

Previous studies have found the prevalence of endometriosis to be in the neighborhood of 60% to 70% in adolescents with chronic pelvic pain that doesn’t improve with nonsteroidal anti-inflammatory drugs or oral contraceptives. 

With advances in laparoscopic techniques able to detect atypical lesions of endometriosis, researchers at Children’s Hospital and Harvard Medical School in Boston hypothesized that an even higher proportion of such adolescents may have lesions of endometriosis.

At the annual meeting of the North American Society for Pediatric and Adolescent Gynecology in Miami Beach, researchers reported the results of laparoscopy in 117 patients younger than 22 years who were referred for chronic pelvic pain. Ninety-eight percent (115 of 117) had endometriosis, all of whom had Stage I or II disease. About half (50.4%) had cyclic pain, 10.4% had acyclic pain only, and 39.1% had both cyclic and acyclic pain.

Other presenting symptoms were gastrointestinal (15.7%), urinary (2.6%), irregular menses (7.8%), and menorrhagia (3.5%). Three-fourths of patients for whom data were available had a family history of endometriosis.

Improved laparoscopic optics, improved visualization of endometrial lesions using newer laparoscopic techniques, biopsy of visually negative pelvises, and greater surgeon experience may account for the increase in the rate of diagnosis of endometriosis at Children’s Hospital, the researchers speculate. They recommend referral of adolescents with refractory chronic pelvic pain to gynecologists experienced with subtle findings of atypical endometriosis.

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