Characteristics and Preoperative Management of Adolescent Patients with Pathology-Confirmed Endometriosis: A...

This multi-institutional, observational, retrospective cohort study aimed to characterize the demographics and preoperative medical management of patients with pathology-confirmed endometriosis.

We reviewed patients <22 years at 8 tertiary care pediatric hospitals in the Midwestern United States who underwent diagnostic laparoscopy and had biopsy-confirmed endometriosis. Patients were identified through pathology records. Demographics, medical history, clinical symptoms, and prior medical management were extracted. Descriptive statistics were computed.

Among 305 patients, median age at first presentation to pediatric and adolescent gynecology (PAG) was 15.6 years (interquartile range: 14.2-17.1). Most patients were White (83.3%) and most had commercial insurance (70.5%). Only 4.3% had a diagnosis of endometriosis prior to their initial presentation to PAG. Common symptoms included progressive dysmenorrhea (76.7%), heavy menstrual bleeding (50.8%), missed school/activities due to dysmenorrhea (55.1%). Patients sought care for their symptoms from a range of providers in addition to PAG, including primary care/adolescent medicine (75.1%), gastroenterology (18.7%), adult gynecology (22.3%), and physical therapy (13.4%). Nearly all patients (92.8%) tried oral hormonal menstrual suppression prior to laparoscopy. Hormonal management included combined oral contraception (62.3%), medroxyprogesterone acetate injection (15.7%), ≤5mg daily norethindrone (14.8%), >5mg daily norethindrone (13.4%), hormonal intrauterine system (13.1%), and contraceptive implant (5.3%).

Patients with pathology-proven endometriosis typically presented with progressive dysmenorrhea, missed school or activities, and heavy menstrual bleeding. They sought care from a variety of providers and while most tried hormonal management of symptoms, the method used varied.