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Minerva Obstetrics and Gynecology 2021 Apr 20

DOI: 10.23736/S2724-606X.21.04764-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Endometriosis in adolescent and young women

Giuseppe BENAGIANO 1 , Paola BIANCHI 2, Sun-Wei GUO 3

1 Department of Maternal and Child Health, Gynecology and Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy; 2 Department of Medico-Surgical Sciences and Translational Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy; 3 Shanghai Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China


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Endometriosis in adolescence represents a specific variant of the disease with its own characteristics and, in some cases, even a possibly different pathogenesis. It has its own clinical presentation, diagnostic and therapeutic modalities. The condition is not rare as once thought and certainly deserves attention in view of increasing evidence of its likely progressive nature. Numerous theories for Its pathogenesis have been formulated and they have been divided into two main categories: the ‘in-situ’ and the ‘transplantation’ hypotheses. Clinical manifestations include as the prevailing symptom a persistent chronic pelvic pain, despite medical treatment, manifested under various forms: dysmenorrhea, acyclic chronic pain, acute abdominal pain and migraines. These symptoms can substantially affect the quality of life on an adolescent. At histopathology, adolescent endometriosis is characterized by a high proportion of subtle, clear, red or vesicular implants and by the rarity of deep nodules. Frequently, the picture includes ovarian endometriomas. In some adolescent girls, lesions may regress or even disappear, probably through immune suppression; in others, chronic stress, unhealthy diet or lifestyle such as high-fat diet, may accelerate lesional progression and cause symptoms. Classically, management of adolescent endometriosis has been centered on attempts to treat dysmenorrhea; today both medical and surgical modalities have the potential to improve quality of life, alleviate symptoms, prevent the development of more severe disease and minimize risks for future fertility in adolescents. Nonetheless, at present, medical treatments are considered the first line of interventions in treating young women.


KEY WORDS: Adolescent endometriosis; Müllerian remnants; Chronic pelvic pain; Disease progression; Pathogenesis; Treatment

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