Performing an MRI in adolescents presenting with severe dysmenorrhea may hasten diagnosis of endometriosis, suggests a study published in the journal Fertility and Sterility.¹ 

In this prospective study, Millisher et al recruited 345 adolescent girls aged 12-20 years, who had been referred for pelvic MRI scans between September 2019 and June 2020 for severe dysmenorrhea. Through this study, they aimed to characterize the phenotypes of endometriosis, ovarian endometrioma and deep infiltrating endometriosis and their distribution. Participants with presumed superficial endometriosis with no radiologic signs of endometrioma or deep infiltrating endometriosis were not included in the trial.

Almost 40% of the participants were found to have endometriosis on MRI, while 11.4% had adenomyosis. Among those with endometriosis, nearly 21% had ovarian endometrioma and 88.4% had deep infiltrating endometriosis.

The prevalence of endometriosis was found to increase with age. Girls aged 15-18 years were twice more likely to have endometriosis on MRI with odds ratio (OR) of 2.3 compared to those younger than 15 years of age. Those aged 18-20 years had 3 times higher chances of having MRI features of endometriosis with OR of 3.3. Occurrence of adenomyosis, retrocervical lesions, intestinal lesions also increased with age. Myometrial contractions were also recorded for all study subjects and were visible in 34.4.%. The uterine contractions also increased with age but they had no significant association with endometriosis. The scores on visual analog scale scores were similar for subjects with and without endometriosis.

Diagnosing endometriosis in adolescents is not easy. A wait and watch strategy is usually adopted in adolescents with dysmenorrhea. Diagnostic laparoscopy is seldom carried out. Physicians should be aware that such adolescents may have endometriosis. In this study, many adolescents were found to have severe phenotypes of endometriosis. Use of imaging modalities such as MRI in this age group with symptoms strongly suggestive of endometriosis can reduce the delay in diagnosis. This will also prevent a negative impact on the quality of life.

Reference

1. Millischer AE, et al. Adolescent endometriosis: prevalence increases with age on magnetic resonance imaging scan. Fertil Steril. 2023 Apr;119(4):626-633. doi: 10.1016/j.fertnstert.2022.12.039.