ACOG Guidance on Evaluation and Management of Endometriosis and Dysmenorrhea in Adolescents
ACOG has released recommendations on the diagnosis and management of dysmenorrhea and endometriosis in adolescents.
The goals of therapy include symptom relief, suppression of disease progression, and protection of future fertility. Therapy must be individualized, and obstetrician–gynecologists should consider patient choice, the need for contraception, contraindications to hormone use, and potential adverse effects and counsel the adolescent and her family on treatment options.
Endometriosis is a chronic condition that results in infertility and chronic pain. Clinical manifestations vary and are not good predictors of the severity of the disease. Dysmenorrhea, chronic pain, dyspareunia, uterosacral ligament nodularity, and adnexal masses are among the common presentations. Treatment is aimed at optimizing pregnancy rates and minimizing symptoms; definitive treatment remains removal of the ovaries, fallopian tubes and uterus.
Chronic pelvic pain
Uterosacral ligament nodularity
Bowel and bladder symptoms, such as dyschezia, hematochezia, hematuria, dysuria
Symptoms do not correlate with severity of disease
Definitive diagnosis is surgical and made on histology of lesions removed. Lesions can be black powder-burn, red or white
Imaging studies are useful only in the presence of a pelvic/adnexal mass
Transvaginal ultrasound is the technique of choice in differentiating an endometrioma from other adnexal masses, and in detecting deeply infiltrating endometriosis of the rectum or rectovaginal septum
MRI can be used when ultrasound results are equivocal
American Society for Reproductive Medicine (ASRM) classification system is most commonly used, but is not a good correlate with fertility or symptoms
Pain associated with endometriosis can be reduced with use of:
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