The push is on to recognize endometriosis in adolescents

Meredith Loveless, MD, a pediatric and adolescent gynecologist who chairs ACOG’s Committee on Adolescent Health Care, is leading the development of a new ACOG committee opinion on dysmenorrhea and endometriosis in adolescents. The laparoscopic appearance of endometriosis in young patients and the need “for fertility preservation as a priority” in surgery will be among the points discussed in ACOG’s upcoming guidance, she said.

“Somebody who manages adult endometriosis and who does extremely aggressive surgical work may actually be harming an adolescent rather than helping them,” said Dr. Loveless of the Norton Children’s Hospital in Louisville, Ky. (Dr. Loveless has also worked with the American Academy of Pediatrics and notes that the academy provides education on dysmenorrhea and endometriosis as part of its national conference.)

Nicole Donnellan, MD, of the University of Pittsburgh Magee–Womens Hospital, said that fertility preservation is always a goal – and is possible – regardless of age. “A lot of us who are advanced laparoscopic surgeons are passionate about excision because (with other approaches) you’re not fully exploring the extent of the disease – what’s behind the superficial things you see,” she said. “Whether you’re 38 and wanting to preserve your fertility, or whether you’re 18, I’m still going to use the same approach. I want to make sure you have a functioning tube, ovaries, and uterus.”

Ken R. Sinervo, MD, medical director of the Center for Endometriosis Care in Atlanta, which has followed patients postsurgically for an average of 7-8 years, said adhesions can occur "whether you're ablating the disease or excising it," and that in his excisional surgeries, he successfully prevents adhesion formation with the use of various intraoperative adhesion barriers as well as bioregenerative medicine to facilitate healing. The key to avoiding repeat surgeries is to "remove all the disease that is present," he emphasized, adding that the "great majority of young patients will have peritoneal disease and very little ovarian involvement."*