Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis
Open accessAbstract
Objective To evaluate the ultrasonographic presence of different forms of endometriosis and the associated clinical symptoms in adolescent women.Design Retrospective observational study.Setting University hospital.Patient(s) Two hundred and seventy women aged 12-20 years referred to the gynecologic ultrasound unit from January 2014 to June 2019.Intervention(s) Two-dimensional, three-dimensional, and power Doppler ultrasound (US) pelvic examination (transvaginal or transrectal in pre-sexually active adolescents) were performed in all included adolescents. Medical history was collected for each patient before the scan.Main outcome measure(s) All possible locations of endometriosis evaluated and recorded using a dedicated ultrasound mapping sheet and severity of painful symptoms evaluated through a visual analogue scale (VAS).Result(s) Dysmenorrhea was detected in 147 (54.4%) of 270 patients and heavy menstrual bleeding in 76 (28.1%) of 270. At least one ultrasound feature of endometriosis was identified in 36 (13.3%) of 270 cases. Ovarian endometriomas were found in 22 (11%) patients, adenomyosis in 16 (5.2%), and deep infiltrating endometriosis (DIE) in 10 (3.7%). Ultrasound signs of endometriosis were found in 21% of adolescents who reported dysmenorrhea and 33% with dyspareunia. The presence of DIE at ultrasound was associated with bowel symptoms in 33% of patients and associated with dyspareunia in 25% of patients.Conclusion(s) The detection rate of pelvic endometriotic lesions at ultrasound was 13%. The rates of dysmenorrhea, dyspareunia and heavy menstrual bleeding in adolescents with endometriosis ultrasound signs were statistically significantly higher compared with those without. In patients with dysmenorrhea, the detection rate of pelvic endometriosis at ultrasound increased to 20%. Professionals involved with teens should be aware of the clinical presentation of endometriosis to reduce the delay between the onset of symptoms and the diagnosis, referring these young women to dedicated centers.
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Transvaginal US is effective in diagnosing ovarian endometriosis in adolescents.
“Transvaginal US is recommended to be used in adolescents in whom it is appropriate, as it is effective in diagnosing ovarian endometriosis.”
From ESHRE guideline: endometriosis (2022) · cites this paper as Martire et al., 2020
The rate of concurrent pelvic endometriosis and/or adenomyosis in this CSE cohort (45.1%) is higher than that reported in the general population.
“This rate of our result is higher than that reported for pelvic endometriosis and adenomyosis in the general population23,24 and may be correlated.”
From Risk Factors for Postoperative Recurrence of Cesarean Scar Endometriosis (2024) · cites this paper as [23]
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- Authors
- Martire, F. G., Lazzeri, L., Conway, F., Siciliano, T., Pietropolli, A., Piccione, E., Solima, E., Centini, G., Zupi, E., & Exacoustos, C.
- Affiliations
- University of Rome Tor Vergata (IT)
- University of Siena (IT)
- ASST Fatebenefratelli Sacco (IT)
- Corresponding author
- Martire, Francesco G.
- ORCID
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 114
- Issue
- 5
- Pages
- 1049-1057
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W3091823183
- Cited by
- 103
- References
- 26
- Citations by year
- 2026: 19 · 2025: 17 · 2024: 27 · 2023: 12 · 2022: 18 · 2021: 9 · 2020: 1
- FWCI
- 8.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
- Use Siena air (University of Siena) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- endometriosis, adolescent women, pelvic endometriosis, ultrasonographic signs, dysmenorrhea, dyspareunia, menorrhagia, deep infiltrating endometriosis, endometrioma, adenomyosis, power Doppler, early diagnosis, bowel symptoms
- MeSH terms
- Adolescent, Age Factors, Child, Dysmenorrhea, Endometriosis, Female, Humans, Retrospective Studies, Pelvic Pain, Ultrasonography, Doppler, Early Diagnosis, Young Adult
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