Endometriosis in adolescents: A state-of-the-art review

Endometriosis, once considered rare in adolescents, is now recognized as a common cause of chronic pelvic pain and dysmenorrhea in individuals aged 10-21. This state-of-the-art review explores the evolution of knowledge regarding adolescent endometriosis from early misconceptions to current clinical understanding, highlighting epidemiology, pathophysiology, current diagnostic and management strategies, psychosocial implications, and key knowledge gaps. Adolescents often present with acyclic pain, and associated gastrointestinal (GI) or systemic symptoms, leading to frequent diagnostic delay. Laparoscopy remains the gold standard for diagnosis, though noninvasive strategies are increasingly being developed due to limitations in surgical access and risks of underdiagnosis. Lesions often appear atypical in adolescents, which can cause missed diagnosis. First-line treatment is suppression with hormonal medications and NSAIDs. Surgical intervention is generally reserved for refractory cases, but postoperative recurrence remains high without ongoing hormonal suppression. Psychosocial impacts of endometriosis in adolescents are profound, leading to significant impacts on school participation, emotional health, and social development.