Endometriosis is the most common cause of secondary dysmenorrhea in adolescents. It is a challenging condition to detect in this age group and is likely to be missed or diagnosed late. In a  Committee Opinion, the ACOG asserts that “in adolescents, endometriotic lesions are typically clear or red and can be difficult to identify for gynecologists unfamiliar with endometriosis in adolescents”.¹

A study published in the journal Fertility and Sterility states that imaging can facilitate early diagnosis in adolescents who have symptoms suggestive of endometriosis.² It highlights the role of MRI in early diagnosis of endometriosis in adolescents who present with severe dysmenorrhea not relieved with NSAIDs.

For this study, 345 girls aged 12-20 years with severe dysmenorrhea and who underwent multiplanar pelvic MRI with cine MRI examination between September 2019 and June 2020 were enrolled in this prospective study with the aim to evaluate the prevalence of endometrioma and/or deep infiltrating endometriosis in this age group. Myometrial contractions were recorded for individual subjects and a visual analogue scale (VAS) was used to assess the severity of dysmenorrhea. Patients with no radiologic evidence of endometrioma or deep infiltrating endometriosis were not included in the trial.

Results showed that nearly 61% (n=187) of adolescents did not have endometriosis on MRI examination, while endometriosis was detected in 121 (39.3%) participants. In the endometriosis group, 25 (20.7%) had endometrioma, 107 (88.4%) had deep infiltrating endometriosis; 21 (17.3%) had associated adenomyosis. The prevalence of endometriosis increased with increasing age. The odds ratio for endometriosis at MRI for girls aged 15-18 years was 2.3 vs those below 15 years of age. The odds ratio increased to 3.3 among 18-20-year-olds vs girls younger than 15 years of age.

Uterine contractions were evident in 34.4% patients; however, the contractions had no specific association with endometriosis. Similarly, no particular risk factors associated with endometriosis were identified. Of note, the VAS scores were comparable between adolescents with endometriosis. Though the prevalence of uterine contractions and adenomyosis, intestinal lesions increased with age.

In adolescents with severe dysmenorrhea, a possibility of endometriosis should be considered. Early diagnosis and intervention improves quality of life for the patient.

References

1. ACOG Committee Opinion No. 760: Dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol. 2018 Dec;132(6):e249-e258. doi: 10.1097/AOG.0000000000002978
2. Millischer AE, et al. Adolescent endometriosis: prevalence increases with age at MRI scan. Fertil Steril. 2022 Dec 30;S0015-0282(22)02131-8. doi: 10.1016/j.fertnstert.2022.12.039.