Endometriosis in Adolescents: A Closer Look at the Pain Characteristics and Atypical Symptoms: A Prospective Cohort Study

Overview

Journal J Clin Med

Specialty General Medicine

Date 2025 Feb 26

PMID 40004922

Authors

Maria Federica Viscardi

Ilaria Piacenti

Angela Musella

Laura Cacciamani

Maria Grazia Piccioni

Lucia Manganaro

Ludovico Muzii

Maria Grazia Porpora

Affiliations

Soon will be listed here.

Abstract

: Endometriosis affects up to 10% of women of reproductive age and about 47% of adolescents with pelvic pain. Symptoms include dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Adolescents often present atypical symptoms that can make endometriosis more difficult to diagnose. This study aimed to compare characteristics of pain, atypical symptoms, and the effects of hormonal treatments between adolescents and adults with endometriosis. : A total of 238 women with endometriosis were included: 92 aged 12-18 (group A) and 146 over 18 (group B). Data on menarches, cycle length, comorbidities, dysmenorrhea, dyspareunia, CPP, analgesic use, pain characteristics, atypical symptoms, and endometrioma size were recorded. The efficacy, compliance, and side effects of hormonal treatments were also assessed. Quality of life (QoL) was measured using the SF-12 questionnaire at baseline and after six months of therapy. : Adolescents had earlier menarche ( < 0.001), longer menstrual periods ( < 0.001), and higher analgesic use ( = 0.001) compared to adults. Dysmenorrhea was more frequent ( = 0.01), lasted longer ( < 0.001), and was associated with higher pain scores ( < 0.001) in adolescents. CPP was more common in adolescents ( < 0.001), often described as "confined" ( = 0.04) and "oppressive" ( = 0.038), while adults reported it as "widespread" ( = 0.007). Headaches ( < 0.001) and nausea ( = 0.001) were also more frequent in adolescents. Both groups showed significant improvement in QoL with hormonal treatment ( < 0.001) and reported minimal side effects. : Adolescents with endometriosis often present with earlier menarche, longer menstrual periods, more severe dysmenorrhea, and atypical symptoms. Hormonal contraceptives and dienogest are effective and safe treatments that improve pain and QoL.

References

Zannoni L, Giorgi M, Spagnolo E, Montanari G, Villa G, Seracchioli R . Dysmenorrhea, absenteeism from school, and symptoms suspicious for endometriosis in adolescents. J Pediatr Adolesc Gynecol. 2014; 27(5):258-65. DOI: 10.1016/j.jpag.2013.11.008. View

Giudice L, Kao L . Endometriosis. Lancet. 2004; 364(9447):1789-99. DOI: 10.1016/S0140-6736(04)17403-5. View

Miller J, Missmer S, Vitonis A, Sarda V, Laufer M, DiVasta A . Prevalence of migraines in adolescents with endometriosis. Fertil Steril. 2018; 109(4):685-690. DOI: 10.1016/j.fertnstert.2017.12.016. View

Manganaro L, Vittori G, Vinci V, Fierro F, Tomei A, Lodise P . Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration. Magn Reson Imaging. 2012; 30(10):1432-8. DOI: 10.1016/j.mri.2012.05.006. View

Shah D, Correia K, Vitonis A, Missmer S . Body size and endometriosis: results from 20 years of follow-up within the Nurses' Health Study II prospective cohort. Hum Reprod. 2013; 28(7):1783-92. PMC: 3685336. DOI: 10.1093/humrep/det120. View

Wei Y, Liang Y, Lin H, Dai Y, Yao S . Autonomic nervous system and inflammation interaction in endometriosis-associated pain. J Neuroinflammation. 2020; 17(1):80. PMC: 7060607. DOI: 10.1186/s12974-020-01752-1. View

Gruber T, Mechsner S . Pathogenesis of Endometriosis: The Origin of Pain and Subfertility. Cells. 2021; 10(6). PMC: 8226491. DOI: 10.3390/cells10061381. View

Nodler J, DiVasta A, Vitonis A, Karevicius S, Malsch M, Sarda V . Supplementation with vitamin D or ω-3 fatty acids in adolescent girls and young women with endometriosis (SAGE): a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr. 2020; 112(1):229-236. PMC: 7326593. DOI: 10.1093/ajcn/nqaa096. View

DiVasta A, Vitonis A, Laufer M, Missmer S . Spectrum of symptoms in women diagnosed with endometriosis during adolescence vs adulthood. Am J Obstet Gynecol. 2017; 218(3):324.e1-324.e11. DOI: 10.1016/j.ajog.2017.12.007. View

10.

Oladosu F, Tu F, Hellman K . Nonsteroidal antiinflammatory drug resistance in dysmenorrhea: epidemiology, causes, and treatment. Am J Obstet Gynecol. 2017; 218(4):390-400. PMC: 5839921. DOI: 10.1016/j.ajog.2017.08.108. View

11.

Kvaskoff M, Bijon A, Clavel-Chapelon F, Mesrine S, Boutron-Ruault M . Childhood and adolescent exposures and the risk of endometriosis. Epidemiology. 2013; 24(2):261-9. DOI: 10.1097/EDE.0b013e3182806445. View

12.

Galandrini R, Porpora M, Stoppacciaro A, Micucci F, Capuano C, Tassi I . Increased frequency of human leukocyte antigen-E inhibitory receptor CD94/NKG2A-expressing peritoneal natural killer cells in patients with endometriosis. Fertil Steril. 2007; 89(5 Suppl):1490-6. DOI: 10.1016/j.fertnstert.2007.05.018. View

13.

Nnoaham K, Webster P, Kumbang J, Kennedy S, Zondervan K . Is early age at menarche a risk factor for endometriosis? A systematic review and meta-analysis of case-control studies. Fertil Steril. 2012; 98(3):702-712.e6. PMC: 3502866. DOI: 10.1016/j.fertnstert.2012.05.035. View

14.

Nezhat C, Vang N, Tanaka P, Nezhat C . Optimal Management of Endometriosis and Pain. Obstet Gynecol. 2019; 134(4):834-839. DOI: 10.1097/AOG.0000000000003461. View

15.

Tsonis O, Barmpalia Z, Gkrozou F, Chandraharan E, Pandey S, Siafaka V . Endometriosis in adolescence: Early manifestation of the traditional disease or a unique variant?. Eur J Obstet Gynecol Reprod Biol. 2020; 247:238-243. DOI: 10.1016/j.ejogrb.2020.01.045. View

16.

Smorgick N, As-Sanie S, Marsh C, Smith Y, Quint E . Advanced stage endometriosis in adolescents and young women. J Pediatr Adolesc Gynecol. 2014; 27(6):320-3. DOI: 10.1016/j.jpag.2013.12.010. View

17.

Dun E, Kho K, Morozov V, Kearney S, Zurawin J, Nezhat C . Endometriosis in adolescents. JSLS. 2015; 19(2). PMC: 4432718. DOI: 10.4293/JSLS.2015.00019. View

18.

Saridogan E . Adolescent endometriosis. Eur J Obstet Gynecol Reprod Biol. 2016; 209:46-49. DOI: 10.1016/j.ejogrb.2016.05.019. View

19.

Masciullo L, Viscardi M, Piacenti I, Scaramuzzino S, Cavalli A, Piccioni M . A deep insight into pelvic pain and endometriosis: a review of the literature from pathophysiology to clinical expressions. Minerva Obstet Gynecol. 2021; 73(5):511-522. DOI: 10.23736/S2724-606X.21.04779-1. View

20.

. ACOG Committee Opinion No. 760: Dysmenorrhea and Endometriosis in the Adolescent. Obstet Gynecol. 2018; 132(6):e249-e258. DOI: 10.1097/AOG.0000000000002978. View