The clinical diagnosis of pelvic endometriosis in adolescents

We present a review of available diagnostic tools for adolescent endometriosis, a condition that may have a different pathogenesis than the adult form and therefore necessitates specific methodologies. The new theory provides that endometrial stem/progenitor cells in neonatal uterine bleeding may be causally linked to early-onset endometriosis, thereby explaining both the occurrence in pre-menarcheal girls and its severity in some adolescents. Severe disease seems characterised by the presence of ovarian endomerioma. Disagreement exists in published studies and among specialists on the seriousness and tendency to progress of adolescent endometriosis: some investigators have published series where the vast majority of cases were stage I and II, whereas, others have presented cohorts in which severe disease was relatively frequent. The first and most important sign indicating the possible presence of endometriosis is treatment-resistant dysmenorrhea, to the point that it seems possible to predict an increased risk of endometriosis in girls with an early-onset of this symptom. At the same time, dysmenorrhea alone cannot be sufficient for a proper diagnosis. Therefore, clinical conditions that may increase the occurrence of neonatal bleeding may represent additional signs of an increased risk of early-onset endometriosis. Among them, preeclampsia, postmaturity, feto-maternal incompatibility and low birth weight at or around term.