Endometriosis In Adolescents

Menstrual cramps and pelvic pain are common problems in adolescence. However, endometriosis is detected in one-third of the adolescents with chronic (long-term) groin pain. Endometriosis is a disease caused by the localization of cervical membrane on intra-abdominal organs leading adhesions of these organs on each other with minimal bleedings on each menstruation period. There are many theories concerning their formation mechanisms and there are evidences supporting all these. Most accepted theory is passage of the cervical membrane through the tubes with menstrual bleeding and its localization within the abdomen, in some of the congenital cervical anomalies, menstrual bleeding can’t be discharged or discharged very slowly and endometriosis is very common in such patients. Another theory is transformation of embryonic tissues into cervical membrane tissue with estrogen effect; endometriosis formerly thought to occur several years after the first menarche, new studies showed that endometriosis may develop without menarche following to breast development. Endometriosis may also have an inherited characteristic, is more common among relatives. It is known that the mothers having endometriosis realize the symptoms in their daughters and admit to a physician earlier.

Patients usually admit with abdominal pain, that pain may be menstrual pain or may be independent from menstrual pain. Sometimes urinary tract or digestive system complaints may accompany, too. However, chocolate cysts formed by endometriosis within ovaries is not much common in adolescents.

In order for a definite diagnosis of endometriosis, surgical examination is required but diagnosing it surgically don’t change the prognosis of endometriosis. After excluding other reasons for pain, empirical treatment is started with pain killers called as NSAID. Endometriosis is detected in 70% of the adolescents who underwent laparoscopy due to no response to these medications. Endometriosis is a progressing disease, Combined Oral Contraceptives used in the treatment of adolescents may also slow the progression of the disease. When birth control pills are used for protection, they regulate menstruation as once a month but in the treatment of endometriosis, arrangement should be by taking the medication for 3 months without interval continually and have menstruation for a week. Differently than the adults, GnRH analogues and long-acting depot medroxyprogesterone acetate use in adolescents below 16 years old is not preferred due to their possible negative effects on bone development ; due to the increasing effect of the male hormone, danazol is not preferred, either. Progestins can also be used in the treatment.

Attention: Surgical intervention is not always required for chocolate cysts, since ovarian reserve reduces by each chocolate cyst operation, surgery should be avoided as much as possible and follow ups should be continued with medication treatment.

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