(21) Characteristics and Preoperative Management of Pediatric and Adolescent Patients with Pathology Proven Endometriosis

Background: Endometriosis is a significant cause of dysmenorrhea and chronic pelvic pain in adolescents. Treatment includes both medical and surgical interventions. Patients with pathology proven endometriosis have primarily been examined through single-institution case series and preoperative management has been sparsely characterized. This multi-institutional study sought to characterize demographics and preoperative management of patients who underwent laparoscopy and had pathology confirmed endometriosis.

Methods: Preliminary review of surgical patients < 22 years at 6 of 8 tertiary care pediatric hospitals was completed. Patients were identified through pathology records. Demographics, illness history, and prior medical management were extracted. Descriptive statistics were computed.

Results: Among 225 patients, median age was 15.8 years (IQR: 14.6, 17.4) at first presentation to gynecology. Most patients were white (82.2%) and most had commercial insurance (72.0%). Many patients had a family history of endometriosis (43.1%), 68.0% of these were in a first degree relative. Only 5.3% had a diagnosis of endometriosis prior to first presentation to gynecology. Median number of PAG visits prior to diagnostic laparoscopy was 2 (IQR: 1, 5). Median duration between menarche and index operation was 5.2 years (IQR: 3.8, 7.0). Most patients reported progressive dysmenorrhea (76.0%) and heavy menstrual bleeding (59.1%). Cycle length irregularities (frequent menses in 21.3%, infrequent menses in 13.8%) were relatively uncommon. Most patients missed school or activities for dysmenorrhea (62.2%). Associated symptoms mostly included nausea (39.6%) though many patients were asymptomatic aside from dysmenorrhea (41.8%). Patients sought care for their symptoms with a range of providers in addition to PAG including primary care or adolescent medicine (82.2%), gastroenterology (22.2%), adult gynecology (19.6%), and physical therapy (16.9%). Previous hormonal medical treatment was most commonly combined hormonal contraception (68.4%), followed by depo-provera (20.4%), oral progestin (low dose in 20.0%, high dose in 17.8%), hormonal intrauterine device (16.0%), and contraceptive implant (5.3%). Most patients had used nonsteroidal anti-inflammatory drugs (80.4%) or acetaminophen (42.2%) for pain management.

Conclusions: Patients diagnosed with pathology proven endometriosis presented with progressive dysmenorrhea, missed school or activities, and heavy menstrual bleeding. Patients sought care from a range of providers. No standard hormonal contraceptive regimen was tried preoperatively. Patients most commonly tried combined hormonal methods.