Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis

Fertil Steril. 2020 Nov;114(5):1049-1057. doi: 10.1016/j.fertnstert.2020.06.012. Epub 2020 Oct 6.


Objective: To evaluate the ultrasonographic presence of different forms of endometriosis and the associated clinical symptoms in adolescent women.

Design: Retrospective observational study.

Setting: University hospital.

Patient(s): Two hundred and seventy women aged 12-20 years referred to the gynecologic ultrasound unit from January 2014 to June 2019.

Intervention(s): Two-dimensional, three-dimensional, and power Doppler ultrasound (US) pelvic examination (transvaginal or transrectal in pre-sexually active adolescents) were performed in all included adolescents. Medical history was collected for each patient before the scan.

Main outcome measure(s): All possible locations of endometriosis evaluated and recorded using a dedicated ultrasound mapping sheet and severity of painful symptoms evaluated through a visual analogue scale (VAS).

Result(s): Dysmenorrhea was detected in 147 (54.4%) of 270 patients and heavy menstrual bleeding in 76 (28.1%) of 270. At least one ultrasound feature of endometriosis was identified in 36 (13.3%) of 270 cases. Ovarian endometriomas were found in 22 (11%) patients, adenomyosis in 16 (5.2%), and deep infiltrating endometriosis (DIE) in 10 (3.7%). Ultrasound signs of endometriosis were found in 21% of adolescents who reported dysmenorrhea and 33% with dyspareunia. The presence of DIE at ultrasound was associated with bowel symptoms in 33% of patients and associated with dyspareunia in 25% of patients.

Conclusion(s): The detection rate of pelvic endometriotic lesions at ultrasound was 13%. The rates of dysmenorrhea, dyspareunia and heavy menstrual bleeding in adolescents with endometriosis ultrasound signs were statistically significantly higher compared with those without. In patients with dysmenorrhea, the detection rate of pelvic endometriosis at ultrasound increased to 20%. Professionals involved with teens should be aware of the clinical presentation of endometriosis to reduce the delay between the onset of symptoms and the diagnosis, referring these young women to dedicated centers.

Keywords: Adolescence; diagnosis; endometriosis; pain; ultrasound.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Age Factors
  • Child
  • Dysmenorrhea / diagnostic imaging
  • Dysmenorrhea / epidemiology
  • Early Diagnosis
  • Endometriosis / diagnostic imaging*
  • Endometriosis / epidemiology*
  • Female
  • Humans
  • Pelvic Pain / diagnostic imaging
  • Pelvic Pain / epidemiology
  • Retrospective Studies
  • Ultrasonography, Doppler / methods*
  • Young Adult