Endometriosis is a disease of women of reproductive age, which is between menarche (the first menstruation during puberty) and menopause.

Only since the 1980s and the introduction of laparoscopy, endometriosis is recognised as a disease that can affect adolescents and young women, whereas before it was believed that endometriosis in adolescents was rare.

In recent years, endometriosis in adolescents has been recognised as a challenging problem in gynaecology.

A recent review on this topic showed that:

The prevailing symptom of endometriosis in adolescents is persistent chronic pelvic pain, despite medical treatment (hormonal contraceptives and/or pain killers)

Adolescent girls with deep endometriosis had more school absences during menstruation and more frequently, and for a longer period, used an oral contraceptives to treat severe primary dysmenorrhoea. Serious gastrointestinal symptoms, including constipation, diarrhoea, nausea, and vomiting were also reported in adolescents with endometriosis

• In about 60% of the adult patients with endometriosis, symptoms started before these women reached 20 years of age
• Endometriosis in adolescents may be different in appearance from adult endometriosis, and deep lesions seem to be rare.
• There is no evidence on whether treatment of endometriosis in adolescents prevents disease progression (more severe endometriosis later in life)

Not withstanding the difficulty in drawing any definite conclusions from incomplete evidence and occasionally even contradictory results, recent findings indicate that an early onset of chronic pelvic pain at the time of menarche represents a risk factor for severe endometriosis during adolescence. In addition, when endometriosis appears during adolescence, there is likelihood that the disease will progress and, if left untreated, produce adverse effects that go beyond pain, and include infertility. Finally, a majority of adolescent girls with chronic pelvic pain not responding to conventional medical therapy have endometriosis. For all these reasons, an early identification of the disease may go a long way in slowing or preventing progression.

Indeed a number of medical and surgical options exist today for the treatment of endometriosis. An early mini-invasive diagnostic procedure in adolescents with untreatable chronic pelvic pain will lead the gynecologist to an early identification of endometriosis, followed by a personalized treatment. Given what we know, this seems the best way to guide and protect adolescent girls in these circumstances.