Characteristics and Preoperative Management of Adolescent Patients with Pathology-Confirmed Endometriosis: A Multi-Institutional Study.
Document Type
Article
Publication Date
10-2025
Identifier
DOI: 10.1016/j.jpag.2025.04.003
Abstract
STUDY OBJECTIVE: This multi-institutional, observational, retrospective cohort study aimed to characterize the demographics and preoperative medical management of patients with pathology-confirmed endometriosis.
METHODS: 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.
RESULTS: 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%).
CONCLUSIONS: 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.
Journal Title
Journal of pediatric and adolescent gynecology
Volume
38
Issue
5
First Page
629
Last Page
636
MeSH Keywords
Adolescent; Female; Humans; Dysmenorrhea; Endometriosis; Laparoscopy; Menorrhagia; Midwestern United States; Preoperative Care; Retrospective Studies; Cohort Studies
PubMed ID
40318750
Keywords
Endometriosis; Heavy menstrual bleeding; Missed school; Progressive dysmenorrhea
Recommended Citation
Bergus KC, Rachwal B, Asti L, et al. Characteristics and Preoperative Management of Adolescent Patients with Pathology-Confirmed Endometriosis: A Multi-Institutional Study. J Pediatr Adolesc Gynecol. 2025;38(5):629-636. doi:10.1016/j.jpag.2025.04.003
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