Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy.

STUDY

OBJECTIVE

To evaluate adolescent girls with chronic pelvic pain not responding to conventional medical therapy, using advances in operative laparoscopy to determine endometriosis prevalence, clinical stage, and type of lesion.

DESIGN

A descriptive retrospective study of subjects who (1) were referred for the evaluation of chronic pelvic pain, (2) did not respond to a nonsteroidal anti-inflammatory drug and an oral contraceptive pill, and (3) underwent a laparoscopy to determine the etiology of the pelvic pain.

SETTING

Patients referred to a surgical gynecologist in a pediatric/adolescent gynecology and reproductive endocrine academic practice.

PARTICIPANTS

All patients younger than 22 years of age with chronic pelvic pain.

INTERVENTION: Operative laparoscopy to determine the etiology of the chronic pelvic pain.

MAIN OUTCOME MEASURES: Operative laparoscopy results including stage and description of endometriosis.

RESULTS

More than two thirds of the study population (69.6%) was found to have endometriosis. All subjects had either stage I or II as determined by the American Fertility Society's classification system. The nature of the pain in the 32 subjects with endometriosis was both acyclic and cyclic in 20 (62.5%), acyclic only in 9 (28.1%), and cyclic only in 3 (9.4%). Other presenting symptoms included gastrointestinal in 11 (34.3%), urinary in 4 (12.5%), and irregular menses in 3 (9.4%).

CONCLUSIONS

Adolescents with chronic pelvic pain not responding to medical therapy have a high rate of endometriosis and should be referred to a gynecologist who is experienced with the subtle laparoscopic findings of atypical endometriosis to diagnose the etiology of the pelvic pain and initiate appropriate therapy.